Fiona Phillips (Gilmore, Australian Labor Party) Share this | Hansard source

Residents in Gilmore, and indeed all Australians, are experiencing the real benefits of seeing nurse practitioners who have the experience, skills, qualifications and, importantly, passion to provide holistic care for a variety of health conditions. This government's Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill 2024, introduced by the Assistant Minister for Health and Aged Care, will dismantle the barriers to healthcare provision, particularly in rural and remote areas, where there are workforce shortages and gaining access to GPs can be very difficult. Removing the legislative requirement for collaborative arrangements will enhance healthcare accessibility and autonomy for nurse practitioners and eligible midwives and will give patients greater control over their own care.

Currently nurse practitioners and participating midwives are required to enter into a collaborative arrangement with a medical practitioner in order to prescribe Pharmaceutical Benefits Scheme medicines and to provide services under the Medicare Benefits Schedule. This requirement has complicated and hindered access to nurse practitioner care and restricted nurse practitioners' ability to provide well-rounded, immediate and affordable health care to people living in rural and regional communities like my electorate of Gilmore on the south coast of New South Wales.

The changes proposed by the Albanese government will remove the shackles which for too long have prevented our highly educated nurses and midwives from operating to the full extent of their training, skills and experience, something that I know is front of mind for nurse practitioners and GP practices when I have visited local practices across my region. I want to be clear: nurse practitioners do not replace local GPs. However, they are able to offer services that complement their patients' existing health care. A nurse practitioner is a registered nurse with the experience, expertise and authority to diagnose and treat people of all ages who have a variety of acute or chronic health conditions. Nurse practitioners have completed additional university study at master's degree level and are the most senior and independent clinical nurses in our healthcare system. We see trusted nurse practitioners in our local GP practices, and they are absolutely vital to patient care. They are a vital part of our local GP practices.

Local nurse practitioner Natalie Moore runs her own clinic in Milton, in the Gilmore electorate. A registered nurse of more than 30 years and a former decorated ambulance paramedic, Natalie has worked as a geriatric nurse, theatre nurse and director of nursing in both the public and private health sectors. Highly trained and highly experienced, Natalie has worked as a nurse practitioner since 2019, primarily in aged care, where she provided health care for elderly patients living in aged-care facilities and nursing homes when they could not be visited by their doctor due to COVID-19 restrictions. It was during this time that Natalie recognised the need for accessible and affordable health care in her community. Thirteen months ago, Natalie opened her own health and skin cancer clinic, Moore than Health. Natalie is passionate about her community and passionate about providing preventive health care, something she says GPs often overlooked because they were busy addressing acute medical needs.

Natalie is understandably frustrated by the current collaborative arrangements, which require her and other nurse practitioners to be under the microscope of doctors in order to prescribe Pharmaceutical Benefits Scheme medicines to patients and to provide services under the Medicare Benefits Schedule. Having specialised as a nurse in skin cancer medicine, including skin checks and excisions, for almost 10 years, Natalie opened her own clinic and now treats around 40 patients per day. Since opening the doors to Moore than Health, Natalie has seen an increasing number of patients, particularly elderly patients, who have skipped their regular skin checks because they couldn't get in to see a doctor or couldn't afford to see one.

According to the Cancer Council of New South Wales, Australia has one of the highest rates of skin cancer in the world, and about two out of three Australians will be diagnosed with some form of skin cancer before the age of 70. Non-melanoma skin cancer is the most common cancer diagnosed in Australia, so it is important that health professionals like Natalie are on the front foot when it comes to skin checks and preventive medicine. As a nurse practitioner, Natalie can conduct skin checks and excisions and refer patients to a specialist or plastic surgeon if required. The work she does is important. The work she does saves lives, but the current restrictions mean Natalie doesn't get paid by the government for providing longer consultations and services, including surgery to remove skin cancers, under the Medicare Benefits Schedule. Natalie chooses not to pass the full cost of her time on to her patients, because she wants to ensure their health care remains affordable. She doesn't want them to have to choose between having a skin cancer removed and buying groceries. This is outrageous. Here we have a trained, skilled nurse practitioner saving lives, treating patients for potentially deadly skin cancers, yet her expert services are not covered by Medicare. This bill will change that.

Similarly, Natalie can prescribe skin cancer creams for her patients, but many are not available under the Pharmaceutical Benefits Scheme. However, those same medicines, if prescribed by a doctor, are covered by the PBS. Once again, it's the patients that are being hit in the hip pocket because of these legislative requirements. This bill will change that.

Nurse practitioners like Natalie continue to practice collaboratively with other health professionals to improve access to health care for Australian communities through health promotion, disease prevention and health management strategies. They have the expertise and authority to diagnose and treat people of all ages with a variety of acute or chronic health conditions, yet their skills are not being recognised, because many of their services are not covered by the Medicare Benefits Schedule. Our wonderful nurse practitioners have completed additional university study at master's degree level and are the most senior and independent clinical nurses in our health system.

In response to a recommendation by the Medicare Benefits Schedule Review Taskforce, the government commissioned an independent review of collaborative arrangements. The review included analysis of Australian and international literature and extensive stakeholder consultation on the efficiency and appropriateness of collaborative arrangements. The findings of the review supported the need for clinical collaboration between all health professionals. However, it found that the legislative requirement for collaborative arrangements duplicated existing professional standards and guidelines and could create barriers to accessing care. Removing the legislative requirement for a collaborative arrangement will assist in removing barriers to primary care for Australians, particularly in regional, rural and remote areas, where there are known challenges in attracting and retaining GPs.

The professional standards for practice and the safety and quality guidelines issued by the Nursing and Midwifery Board of Australia require registered nurses, midwives and nurse practitioners to engage collaboratively with other health professionals. These standards and guidelines are the appropriate mechanism for the regulation of these health professionals. They do not impose the barriers to care that the legislative requirement for specified collaborative arrangements can cause for nurse practitioners like Natalie.

The title of 'nurse practitioner' can only be used by a person who has been endorsed by the Nursing and Midwifery Board of Australia. With strong support from the nursing and midwifery sectors, this bill will contribute to the long-term goals of the Strengthening Medicare Taskforce and the Nurse Practitioner Workforce Plan. Changing this legislation and supporting our nurse practitioners and midwives to use their skills is good for patients. It's good for the health system and it will encourage more talented people to take up these professions and further their study in health care. It will result in positive change for the Australian community.

This bill will not only bring about change for the nurse practitioners and midwives that are doing extraordinary and important work in our community; it will support women. This bill strongly aligns with the recently released Working for women: astrategy for gender equality. By supporting more effective use of our healthcare workforce, this bill will improve gender equity in healthcare outcomes and take practical action to reduce the gender pay gap. By removing the requirement for collaborative arrangements, this bill also supports the implementation of the women-centred care strategy by providing birthing women with greater choice and access to care and services. Allowing women to choose to receive care by a nurse practitioner or midwife will go a long way towards ensuring women are always treated with respect and dignity in our maternity care system.

We know the care economy, a highly feminised workforce, is often underpaid, undervalued and underutilised. A bill that empowers nurse practitioners and midwives is one that empowers women. As this government works to develop a national strategy for the care and support economy, we will continue to deliver practical, structural changes across our care workforce. As women make up the majority of workers in this sector, this bill will support women's economic equality.

As I said, our nurse practitioners and midwives are highly trained, highly skilled and extremely passionate about their jobs. Nurses have always been at the centre of health care, but under the previous government they had been significantly underutilised and undervalued. The Albanese Labor government has no higher priority than strengthening Medicare to make it easier and cheaper for Australians to get the health care they need when they need it. By removing the legislative requirement for collaborative arrangements, we will make it easier and cheaper for Australians to access health care. We will also unlock the full potential of our wonderful nurses and midwives. I commend this bill to the House.

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