Working in teams

Budget update (May 2010): The Budget contains $390m over four years to provide grants to general practitioners to employ practice nurses. Annual incentive payments of $25,000 per full time GP for a registered nurse and $12,500 per full time GP for an enrolled nurse will be made available to eligible accredited general practices.

Dr Pesce said the AMA supports the extra funding that will allow more general practices to employ a practice nurse and the removal of geographic boundaries on practice nurse subsidy arrangements, although the AMA supports the continuation of special loadings for rural areas as part of the implementation process.

“Practice nurses working as part of a general practice team have been a success story with more than 8,500 practice nurses working across the country,” Dr Pesce said.

“The new arrangements proposed by the Government will support practice nurses to undertake a wider range of work on behalf of GPs than they are currently funded to do.”

(4 June update) AMA is undertaking a survey of members on practice nurses and the new arrangements. Please help out by doing the survey here.

NHHRC recommendation 99: “To improve access to care and reflect current and evolving clinical practice, we recommend that:

Medicare rebates should apply to relevant diagnostic services and specialist medical services ordered or referred by nurse practitioners and other health professionals having regard to defined scopes of practice determined by recognised health professional certification bodies;
Pharmaceutical Benefits Scheme subsidies (or, where more appropriate, support for access to subsidised pharmaceuticals under section 100 of the National Health Act 1953) should apply to pharmaceuticals prescribed from approved formularies by nurse practitioners and other registered health professionals according to defined scopes of practice;
where there is appropriate evidence, specified procedural items on the Medicare Benefits Schedule should be able to be billed by a medical practitioner for work performed by a competent health professional, credentialled for defined scopes of practice; and
the Medicare Benefits Schedule should apply to specified activities performed by a nurse practitioner, midwife or other competent health professional, credentialled for defined scopes of practice, and where collaborative team models of care with a general practitioner, specialist or obstetrician are demonstrated.”

The NHHRC recommends an addition $140-330m per annum to fund these initiatives (NHHRC, p. 252). Optometry MBS rebates alone cost $281.5m in 2008-09 (DoHA, 2009), so it appears that the NHHRC is suggesting a very tight rein on other professionals’ use of MBS and PBS.

AMA recommends:

Improved MBS arrangements to support a broader range of work to be undertaken by GP practice nurses and allied health workers for and on behalf of GPs, and
1300 more GP practice nurse/allied health worker grants by 2011-12.

Dr Steve Hambleton, AMA Vice President, said "Nurse practitioner and midwife access to MBS and PBS funding is now a reality. The AMA has already been working hard to ensure that the close collaboration that has always existed between health care professionals is enhanced and that fragmentation of care - which is both cost inefficient and the enemy of quality care - is prevented. Self-interested radical elements cannot be allowed to unpick the fabric of our health system" (Australian Medicine, 14 Dedcember 2009).