News

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GPs needed to inform nurse practitioner arrangements

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The role of nurse practitioners within primary care teams has, to date, been fraught with competing recommendations relating to clinical scope of practice and responsibilities.
 
In 2019, the Nurse Practitioner Reference Group (NPRG), a sub-committee of the MBS Review Taskforce, released a report outlining recommendations on Medicare items relating to nurse practitioners.
 
In response, the RACGP released a submission, opposing key recommendations to:
 

• expand the scope of practice for nurse practitioners to provide Medicare-funded services
• remove current requirements for nurse practitioners to collaborate with doctors in delivering care to patients
• create new, and expand current, nurse practitioner telehealth items.

 
While the Taskforce did not endorse any recommendations from the NPRG report, it did make three independent recommendations to address outstanding issues – one of which was an independent review of nurse practitioner collaborative arrangements.
 
Commissioned by the Department of Health and now underway, the review strongly endorses collaborative arrangements in ensuring patient safety. It aims to gain insight on what current processes are effective, what can be improved, and how collaborative arrangements should look in the future.
 
As part of the review process and to enable GPs, nurse practitioners, and midwives the opportunity to contribute, feedback is now being sought via an online survey until 26 June.
 
The RACGP is urging members to participate in the survey to ensure GPs’ role within collaborative arrangements and the college’s position on nurse practitioners are clearly defined.
 
Results from the survey will also in part help to inform a new submission the college is preparing for the review of nurse practitioner collaborative arrangements.
 
Professor of General Practice Dimity Pond is consulting on that submission. She told newsGP that GPs’ feedback is valuable in shaping the outcomes of the review.
 
‘GPs who have participated in the collaborative arrangements have important experience of the strengths and weaknesses of that system,’ Professor Pond said.
 
‘Nurse practitioners are important members of the primary health team. We need to work together in ways that optimise healthcare for our patients, and this review is important for that.’
 
Established in 2010, collaborative arrangements provide guidance on the functions and responsibilities of nurse practitioners in relation to referrals, consultation and record keeping. However, existing arrangements do not refer to scope of clinical practice.
 
‘Consideration should be given during the review to the responsibilities of the other parties in
the collaboration to ensure that referrals are made according to the defined clinical scope of practice of the nurse practitioner so that patients receive safe and appropriate care,’ the MBS Review Taskforce report findings state.
 
Concerns were previously raised by GPs around proposals to grant nurse practitioners to practice autonomously in the primary healthcare sector, while a push to open nurse-led clinics in some states was met with resistance around expensive and fragmented models of care.
 
The RACGP supports nurse practitioners as part of a GP-led practice team, highlighting in a recent submission to the Nurse Practitioner 10-Year Plan that while their role should be imbedded in collaborative arrangements, providing care outside of a patient’s usual GP will result in fragmentation, and should be offered as a ‘complementary service’ to GPs.
 
Additionally, in its position statement the college states that ‘independent nurse practitioners seeking the same level of authority, autonomy and scope of practice as GPs will compromise the quality, safety, efficiency and cost effectiveness of patient care’.
 
Clinical settings in which patient care will be provided should be clearly identified in collaborative arrangements, according to the RACGP, and GPs should liaise with nurse practitioners around responsibilities and agreed scope of practice when entering into a collaborative arrangement.
 
Professor Pond agrees.
 
‘Well-structured collaborative arrangements that clearly define roles and responsibilities while allowing for each team member to support the other are potentially very helpful in this space,’ she said.
 
GPs can complete the online survey until 26 June, or email healthreform@racgp.org.au for any additional comments which may be considered for the RACGP’s response to the survey.  
 
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collaborative arrangements collaborative care MBS Review Taskforce nurse practitioners

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