Nurse Practitioner Collaborative Arrangement comes to an end

Landmark new laws scrapping the Nurse Practitioner (NP) Collaborative Arrangement will come into effect on Friday in an expansion of the professions’ scope of practice.
 
Following legislation passing through Federal Parliament in May, as of 1 November, NPs will have greater autonomy to prescribe medicine and provide Medicare services without a GPs’ tick of approval.
 
Currently, NPs and endorsed midwives are not allowed to autonomously provide services under Medicare or prescribe Pharmaceutical Benefits Scheme (PBS) medicines without the supervision of a medical practitioner.
 
But from Friday, the need for a GP’s sign-off is no longer required.
 
The changes were designed to remove barriers to care, particularly in rural and remote areas, and to support healthcare professionals work to their full scope of practice.
 
Australian College of Nurse Practitioners CEO Leanne Boase said the change will enable more people to access funding and subsidies, as well as improving the affordability of care.
 
‘Nurse practitioners will continue to work in the same way from 1 November, delivering the same collaborative and person-centred care,’ she said.
 
‘However, this will reduce the administrative burden for many, allowing them to focus more time on healthcare.’
 
But RACGP Rural Deputy Chair Dr Rod Omond told newsGP the plan not only potentially places patients at risk, but also nurses if they fail to diagnose illnesses.
 
‘Nurse practitioner’s master’s qualification, unfortunately, is not really a clinical qualification, it’s an academic qualification, and it has no clinical examination at the end or anything like getting an FRACGP,’ he said.
 
‘The second thing is, usually they have their masters in a certain area, so if they’re working in cardiac nursing in the hospital, that’s usually the area they’re in, it’s usually not a general primary care qualification.
 
‘The nurses are not fully trained GPs, so they have areas of expertise, but they are not trained to see undifferentiated patients, so patients who might have any problem, and deal with it appropriately.’
 
Currently, there are more than 2200 NPs in Australia, all of which must be a registered nurse with no restrictions on practice, have 5000 hours of experience at the advanced clinical nursing practice level, and complete additional study.
 
Health and Aged Care Assistant Minister Ged Kearney said the change comes following ‘review after review found that Australians were losing out’.
 
‘They were missing out on high quality and timely care, they were waiting longer for appointments and paying more in gap fees, because of this needless red tape,’ she said.
 
‘This is about supporting a workforce that is almost exclusively women, to empower them to become small business owners, to build their own practices and run their own clinics, so that more people get the care they need.’
 
Dr Omond said having GPs and NPs as members of a team-based approach is a more efficient and safer option.
 
‘If you’re not skilling nurses up with the appropriate support to be able to do the job properly, then the only other alternative is to have more GPs in those areas,’ he said.
 
‘A team approach is far better, so have GPs, and have nurses, and physios, and other people working within the same team, with the same patient records – that’s a safe system and more people get seen.’
 
Friday’s changes come as the scope of practice for several healthcare professionals continues to evolve and expand.
 
Expansion for NPs has also been seen in the growth of nurse-led walk-in clinics in the Australian Capital Territory and Tasmania.
 
These controversial centres are staffed with advance practice nurses and NPs and offer free care, but
GPs have already reported multiple incidents of the centres interrupting continuity of care and medical complications being missed.
 
The ending of the Collaborative Arrangement comes on the same week as pharmacists’ scope of practice expansion reaches a significant milestone, with pharmacy prescribing for uncomplicated urinary tract infections now available nationwide.
 
Dr Omond said this theme of scope expansion has potential to put patients in danger, especially if there is inadequate professional backup.
 
‘These very truncated methods of diagnosis are not in the patient’s best interests,’ he said.
 
‘The diagnosis may be wrong and therefore the treatments are not going to work and may also place the patient in danger because they have an undiagnosed condition that should have been treated differently.
 
‘Our emphasis is really pushing that team approach – we do want people to have increased scope of practice, but in the safety of a team.’
 
As of 1 November, references to collaborative arrangements will be removed on the Medicare Benefits Schedule Online, PBS, and Services Australia websites.
 
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