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GP resistance to nurse practitioner Medicare push
The RACGP has flagged its opposition to a proposal that nurse practitioners be granted more autonomy in patient treatment.
The Nurse Practitioner Reference Group (NPRG), a sub-committee of the Medicare Benefits Schedule (MBS) Review Taskforce, released its report containing recommendations on Medicare items relating to nurse practitioners in February this year.
One of its key recommendations was to dismantle the Medicare requirement that nurse practitioners work in collaboration with a doctor when prescribing and providing patient care, arguing it is an ‘impediment to growth of the role in improving access to quality care for all Australians’.
The report also suggested extending MBS rebates to include nurse practitioners in item descriptors for team care arrangements, health assessments, urgent after-hours home visits and aged-care services, and significantly boosting the rebates for existing nurse practitioner attendance items.
‘Basically, the NPRG has claimed that nurse practitioners could provide almost all the services currently provided by GPs so long as they have access to the same MBS item numbers and ability to order investigations,’ Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP.
‘The NPRG claims this will provide choice for patients to select nurse practitioners for their primary care needs and that they will plug current access gaps for vulnerable or remote patient-types.
‘The NPRG further claims that allowing open access to the same patient rebates and referral rights as GPs will reduce fragmentation.’
The MBS report cites research that shows ‘the net benefit of care facilitation services provided by a nurse is seen to be equal to that of a primary care provider or other allied health practitioner providing expert care’.
But Dr Michael Wright, Chair of the RACGP Expert Committee – Funding and Health System Reform (REC – FHSR), strongly disagrees with this finding.
‘Nearly 90% of patients see a GP every year, and so I don't think access to primary care services is the problem,’ he told newsGP. ‘Previous reports from the MBS Review Taskforce have suggested the stewardship role of general practice should be strengthened.
‘Proposals such as the NPRG’s will do the opposite, leading to fragmented siloed services, worse health outcomes, loss of important health information, and further diluting funding from front line general practice services.
‘What we need to be doing is linking services better, support providers to communicate safely securely and consistently, and investing in general practice.’
Associate Professor Morgan believes the more comprehensive training received by GPs better equips them to handle a wide range of healthcare concerns.
‘General practice training involves extremely competitive entry to medical school, six years’ Australian Medical Council-accredited intensive training, postgraduate training of four to five years, Fellowship examinations, continuing professional development,’ he said.
‘This results in a workforce able to manage undifferentiated presentations, emergencies, complex pharmacology decisions, multi-morbidity, thousands of medical conditions including rare conditions, and deal with multiple agenda items within each consultation.’
Associate Professor Morgan is also concerned that the adoption of the NPRG’s recommendations would lead to growing disadvantage for some parts of the Australian population.
‘It would be a dangerous precedent for Australia to accept a two-tier version of primary care, where comprehensive expert care is available in some areas and for some people, while allowing a lower level of autonomous care to replace GPs in other areas,’ he said.
RACGP earlier this week sent a submission to the MBS Review – NPRG, outlining its concerns that the report’s suggestions would result in fragmentation of patient care.
The RACGP makes it clear that it is not opposed to nurse practitioners in general, encouraging their role within GP-led general practice teams.
‘Nurse practitioners can and should continue to work within GP-led collaborative models. They have an important role working within general practices and greatly add to the primary care workforce,’ Dr Wright, who led the development of the RACGP’s submission, said.
‘But adding new groups of health professionals into primary care, and presuming that the complexity of general practice can be distilled into treatment of single conditions, is a mistake.’
In line with its Vision for general practice and sustainable healthcare system, the college would like to see increased funding to support more team-based healthcare, as part of an overall boost in general practice funding.
‘Rather than shifting funding to other primary care providers working in isolation, a better approach would be to increase funding for GPs and practices so they can better provide acute and preventive care, and coordinate care for patients,’ Dr Wright said.
‘The Medicare freeze has removed $1 billion-worth of funding from general practice services. This funding needs to be restored and further increased to strengthen the delivery of primary care. The proposals from the NPRG group will not do this
‘I would be concerned that this proposal will lead to more fragmentation and more siloed care, leading to worse health outcomes and long term increases to health spending.’
MBS Review Medicare Benefits Schedule Review Nurse practitioner reference group Nurse practitioners
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