Nurse practitioner barriers to go ‘within three years’

The federal government’s Nurse Practitioner Workforce Plan recognises the true value of nurse practitioners to the health and aged care sectors.

Rules that prevent nurse practitioners (NPs) from working to their full scope of practice will be scrapped within one to three years under a federal government plan supported by nursing unions.

The Nurse Practitioner Workforce Plan outlines reform targets to be achieved in the short, medium and long terms.

Short-term goals (1–3 years) include giving NPs access to some of the Medicare Benefits Schedule (MBS) items that currently apply only to doctors.

— NP Lorna Scott

In the same period, rules that restrict NPs prescribing medicines on the Pharmaceutical Benefits Scheme (PBS) will also be reviewed. In addition, laws will be reviewed to “set up a nationally consistent model to allow NPs to work to their full scope of practice”, matching their education and competency, the plan states.

These reforms will be accompanied by a “national NP awareness strategy” to promote the NP role. The plan is supported by the Australian Nursing and Midwifery Federation (ANMF), the national umbrella body for state-based nursing unions, including the NSWNMA.

ANMF Federal Secretary, Annie Butler, was a member of the plan’s steering committee.

She said the plan is needed to “recruit and retain NPs, and allow them to play a crucial role in the development of multidisciplinary models of care, which we believe is the future of Australia’s health and aged care systems”.

“The plan recognises the true value of NPs and how they can provide tangible solutions to the many challenges across the health and aged care sectors, which are impacting the delivery of timely, safe health care, particularly in rural and remote communities where there is limited access to a GP, or no GP at all,” Annie said.

“Expanding NPs’ scope of practice and introducing incentives, such as an increase in MBS rebates for their services, could finally allow NPs to provide people with direct access to safe, quality ‘everyday care’, without having to go through a GP.

“This will remove unnecessary duplication, cost and time-wasting for many Australians in underserved communities and ensure they can access quality care when and where they need it.”

The NP workforce plan builds on initial steps to support NPs announced in the May federal budget (see story page 20).

NP Lorna Scott, a member of the NSWNMA’s state council, welcomes the federal government’s NP reforms.

“It’s brilliant to finally see a government committed to change and progress for nurses,” said Lorna, who works as an NP in women’s health.

“The ANMF and Australian College of Nurse Practitioners have been arguing for change and participating in review committees for more than 10 years.

“At the moment, there are not enough positions available for all qualified NPs, but this is slowly changing.

Government plan recognises NPs are under-utilised

The federal government’s NP workforce plan acknowledges the restraints on NPs trying to do their jobs.

It cites the case of “Adam”, an NP at a metropolitan hospital who assesses and treats adult patients diagnosed with cancer. His daily routine ranges from in-person and telephone consultations to reviewing inpatients and patients presenting to ED with complications of cancer or associated treatments.

Adam’s patients require regular CT, MRI, ultrasound, or PET scans, which are not funded by Medicare when ordered by an NP, despite them having the training and competency in interpreting such results.

Adam often must wait to get requests signed by a medical practitioner, which can delay care, as there are days when no oncologist is on site.

Similarly, when prescribing chemotherapy and anti-cancer medicines, Adam must wait to get prescriptions from an oncologist, as there are no PBS rebates for those medicines when prescribed by an NP, despite this being a crucial part of his role.

“These barriers cause significant delays and inconsistencies in care for his patients,” the workforce plan states. n

“I’ve seen new nurse practitioner/ transitional nurse practitioner positions recently created in my own LHD, Hunter New England, which is great.”

Lorna said the government’s commitment under the workforce plan to allow NPs to access MBS item numbers would give NPs a major boost.

“If this reform goes through, NPs in private practice would no longer be restricted to time-based payments under the MBS.

“A review of the rules that prevent NPs from writing some initial prescriptions is also very welcome. “The budget announcement of $50 million for postgraduate scholarships for RNs to become NPs is also very forward thinking.”

She said about 650 NPs were currently working as RNs.

“It’s a lot to put yourself through a master’s degree and get authorised as an NP, then not be able to work in that capacity.

“Hopefully these changes will improve outcomes for all NPs and also be the incentive for nurses working in advanced practice to see the great opportunities that can be had to work as an NP.”

Lorna said Western Australia (WA) was setting the pace of reform with a pilot program to promote NPs working to their full scope of practice under a new multidisciplinary care model.

The federal and WA governments have provided $11.7M to employ 20 NPs in WA primary care settings under the pilot scheme. n