Medicare shake-up to give nurses, midwives a bigger role

The Strengthening Medicare Taskforce has recommended a major expansion of multidisciplinary primary health care.

Aprimary healthcare system in which nurses, midwives and nurse practitioners work to their full scope of practice in multidisciplinary teams delivering complex care.

This scenario is a likely outcome of a major overhaul of Medicare being considered by the federal government.

The Strengthening Medicare Taskforce recommended a major expansion of multidisciplinary care in its report to federal health minister Mark Butler in February.

The Taskforce includes nurse and midwife, doctor and allied health representatives.

Mark Butler set it up to advise on reforms to the 40-year-old Medicare system, which all industry groups agree is no longer fit for purpose.

GP bulk-billing rates are falling, Australians are paying more and waiting longer to see a doctor, and emergency departments are overflowing.

At the same time, the current fee-forservice model is failing communities with restricted access to care, including Aboriginal and Torres Strait Islander Australians, people in many rural and remote areas, and people on low incomes.

“After nine years of cuts and neglect by the former government, primary care is in the worst shape it has been in 40 years,” Mark Butler said. He described an expansion of multidisciplinary care as “the key to managing the health of an older population with more complex and chronic disease”.

New Funding Models

“The Taskforce report recommends supporting this with new, blended funding models, integrated with the existing fee-for-service model, allowing teams of GPs, nurses, midwives and allied health professionals to work together to deliver the care people need,” he said.

“The Taskforce found that strengthening primary care with a greater range of health professionals working to their full scope of practice will optimise use of the health workforce across a stretched primary care sector.”

Annie Butler, Federal Secretary of the Australian Nursing and Midwifery Federation (ANMF), was a member of the Taskforce, which operated for six months (the NSWNMA is the NSW branch of the ANMF).

She described the Taskforce recommendations as “very positive and very promising”.

“There was strong agreement for an increased role for nurses, midwives and a range of allied health professionals in a genuinely multidisciplinary model that does not rely only on a single clinician,” she said.

The ANMF will work to “make sure the intent of the recommendations doesn’t get lost” as industry groups lobby the government over the specifics of its reforms in the next few months.

Historic Opportunity For Reform

“The Albanese government and state and territory leaders must work together and not waste this historic opportunity for reform,” she said.

“They need to ensure that nurses and midwives are at the centre of patient care in the community.

“Nurses, nurse practitioners and midwives provide quality care in every setting in Australia, including in rural and remote settings where often, there are no GPs.

“It’s just common sense to allow them to work to their full scope of practice in these settings.

“With appropriate standalone ‘block funding’ for nurses working in general practice, people would be able to see an RN for a whole range of healthcare and chronic disease management checks, wound care, immunisations, sick certificates and health promotion and prevention.

“This would certainly reduce the number of people having to go to hospital for these everyday care episodes.

“We also want to see outcomebased funding for keeping people well and out of hospital.”

Annie said reform could build on existing models of multidisciplinary care, such as nurse-led clinics in the ACT.

“The ACT clinics are not federally funded but they are a model that we could modify and use.

“They are taking an enormous load off GPs and EDs, while also working really well with a lot of GPs in the area.

“With appropriate policy and the right funding to incentivise the appropriate policy direction, we could see models similar to the ACT clinics spread all over the country.” n

What the Taskforce recommended

When setting up the Strengthening Medicare Taskforce, health minister Mark Butler asked it to advise on:

• improving patient access to general practice

• improving patient access to GP-led multidisciplinary team care, including nursing and allied health

• making primary care more affordable for patients

• improving prevention and management of ongoing and chronic conditions

• reducing pressure on hospitals.

The Taskforce recommended:

• removal of regulatory barriers that stop nurses and allied health workers from using all their skills

• more investment to foster multidisciplinary care teams, including within GP practices

• more investment for regional primary health networks to deploy nurses and allied health workers to GP clinics

• a move to “blended” funding models that combine visit fees with other types of payments, such as a flexible budget for each patient

• voluntary patient registration, where patients are linked with a “home” practice, so they build a relationship with one or more healthcare providers.