Removal of collaborative arrangement requirements an opportunity for “true collaboration”

June 17, 2024

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A midwife consults with a pregnant woman in a healthcare setting.
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In May 2024, the legal requirement for Nurse Practitioners (NPs) and eligible midwives to be part of a ‘collaborative arrangement’ with a medical practitioner to provide certain subsidised services to patients was removed. From 1 November 2024, NPs and eligible midwives can provide services subsidised by the Medicare Benefits Schedule and prescribe certain medicines on the Pharmaceutical Benefits Scheme (PBS) without sign-off from a medical practitioner.

Penny Kenchington, a Nurse Practitioner at the Townsville Sexual Health Service and ASHM Vice President, says the removal of these collaborative requirements are a long overdue sign of progress and recognition for NPs and midwives.

“Nurse Practitioners and eligible midwives have, for too long, been stymied in their practice from this legislation,” says Penny. “We have been the only health professional that has had to, by law, have a collaborative arrangement with a medical doctor to allow our clients be able to access PBS and MBS arrangements,” says Penny.

“This is an amazing moment in time for Nurse Practitioners and eligible midwives to get on with business… It’s a liberating moment and there were a few tears in my eyes when I was reading the Hansard transcript from when the legislation was presented in the Lower House of Parliament.”

The changes aim to remove unnecessary limitations on capable NPs and eligible midwives, and make accessing subsidised healthcare easier for patients. This will be of particular benefit in rural and remote areas where there may be a lack of medical practitioners available or willing to enter into collaborative arrangements.

While an independent review of the collaborative arrangements found that most stakeholders agree the changes will have positive impacts on patient outcomes, a minority were concerned that the changes could result in fragmentation of care.

However, NPs and midwives are required to be credentialled and, under the national codes of conduct for nurses and midwives, work within their scope and refer on to another clinician for appropriate care where needed. The standards of practice for NPs and midwives also contain clauses regarding the need for collaboration for the benefit of patients.

“There’s not going to be fragmentation. Because [NPs], as clinicians, know our boundaries, we know our scope. Just like a GP knows their scope, for example when to send off to the specialist, I also know when to send off to a specialist,” says Penny.

"When people say that there will be fragmentation of care, I can't see that. I can see a coming together of a holistic approach. So that we're wrapping a clinical service around the client."

In fact, Penny sees the removal of the requirements as an opportunity for stronger collaboration and reciprocal relationships between healthcare practitioners, and the smoother provision of person-centered care.  

“A lot of GPs in my town know the health services I can provide and they will send their patient to me. And if I know that some GP out in the community is particularly good in a certain area then I will send my patient to them,” explains Penny.  

“That two-way appreciation and respect for practice is what true collaboration is. It’s not because you must so your patient can get a Medicare rebate.”

While acknowledging the incredible progress marked by the removal of collaborative arrangements, Penny notes that NPs and midwives are still being prevented from working to their full capabilities.

“So much has changed over the past 40 years since I started nursing,” says Penny. “There’s no way we can go backwards and we’ve got to be thinking as a whole group of professionals what we’re going to look like in 40 years’ time, because we can’t sustain what we’re doing now.”

Currently, a national Scope of Practice Review is underway across a variety of healthcare professions, including nurses and midwives, with a focus on “identify[ing] barriers and opportunities for innovation” and “current models of care against community needs”. Findings and recommendations from the review are expected in the second half of 2024.

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