Monique Ryan (Kooyong, Independent) Share this | Hansard source

The Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025 will enable qualified registered nurses to prescribe pharmaceutical benefits under the Pharmaceutical Benefits Scheme. It seeks to implement reforms identified as necessary by the Strengthening Medicare Taskforce and the subsequent scope-of-practice review. The amendments will empower nurses to work to their full scope of practice in primary care. It does make sense that we should do everything possible to ease chronic workforce pressures and provide more equitable access to treatment for people living in rural and remote areas of Australia, in particular.

The prescribing of medications has, in the past, generally been limited to authorised health practitioners, primarily doctors but also some others, including dentists, optometrists, nurse practitioners and midwives, who have been given the ability to prescribe within their defined scope of practice. We have chronic workforce shortages across Australia in a range of healthcare craft groups, and these are generally more pronounced in regional, rural and remote areas. Factors contributing to these workforce shortages include the increasing demand associated with an ageing population, rising levels of chronic disease and barriers to education and training, including the financial barriers associated with the absence of paid practical placements for students taking undertaking training in all healthcare professions in this country.

Nurses play a critical role in providing essential care for Australians. They manage chronic and complex health conditions and keep people out of hospitals. Nurse prescribing is a cost effective intervention which will offer continuity of care, can reduce the workload for other healthcare team members and improve patient satisfaction. Nurses are highly trusted. Australians trust them and consistently rank them as the most trusted profession in health, which I have a small problem with personally but which I get. And they are the single largest health profession in Australia, accounting for more than half of the Australian health workforce and registered nurses working in Australia—in particular, remote area nurses and rural and isolated practice registered nurses are commonly particularly experienced and skilled. Without access to the PBS, nurse prescribed medications would only be available to those patients who can pay for them privately, and that raises significant questions of equity as well as best practice health care.

The Strengthening Medicare Taskforce report from December 2022 was supportive of altering regulatory arrangements to enable all parts of our primary care workforce to work to their full scope of practice. The subsequent review undertaken by the Albanese government proposed recommendations aimed at enabling healthcare professionals, including pharmacists, dental hygienists, nurse practitioners and allied health workers, to work at their full scope of practice. But it's important to note that we're not actually doing that with the legislation in front of the House.

Key recommendations of the scope of practice review included the establishment of a national skills and capability framework for consistent legislation across jurisdictions and new funding models to support multidisciplinary and patient centred care. A major finding of that review is the fact that we have ridiculous but ongoing legislative inconsistencies across Australian states and territories which limit the scope of practice for professionals, such as pharmacists and Aboriginal health practitioners. For example, while pharmacists in some regions can administer vaccines, in others, they are prohibited by law from doing so. Similarly, Aboriginal health practitioners in Queensland are banned from undertaking immunisations even though they've had the necessary training. These sorts of discrepancies contribute to inequities in healthcare access. They increase strain on our workforce, particularly in rural and Indigenous communities, and they really make no sense. Basically, we need a commitment from the federal, state and territory governments to removing barriers, to streamline care across all Australian jurisdictions.

I do note that this legislation expands the ability of registered nurses to prescribe schedule 2, 3, 4 and 8 medications under supervision. Under the new standards for nurse prescribing which came into effect in September 2025, designated RNs who are prescribers will have to have 5,000 hours of post-registration clinical experience and to have completed specific training. They have to prescribe in partnership with an authorised health practitioner and complete a six-month period of clinical membership after accreditation. A model in which a suitably qualified RN works closely with a doctor to try to titrate a medication to meet patient needs does seem reasonable, but it would be appropriate to limit authorisations for that sort of oversight to professionals who are free of commercial conflicts of interest. And it makes sense that nurses are given access to prescribable medications which have been carefully selected such as to secure that they're safe and appropriate.

It is disappointing that this legislation extends prescribing capacity only to registered nurses. I note that the podiatry endorsement for scheduled medicines registration standard has been in place for years, but we still haven't given podiatrists the ability to be authorised prescribers under the PBS. There's no rationale for this anomaly. In order to optimise scope of practice for health professionals, we could act today to expand authorised prescribers under the PBS to include all professions which are currently endorsed to prescribe. It would be reasonable to expect that, if we did so, in addition to immediately enabling podiatrists to act independently, we could in short order allow optometrists to prescribe oral medications and potentially increase access to prescribing for physiotherapists and for other craft groups.

There are some potential pitfalls to expanding the ability to prescribe to healthcare professionals who have not traditionally been given that remit. These include the danger of fragmented care, duplication of services, increased complexity, role confusion and poorer health outcomes. If the professionals who are prescribing don't have adequate diagnostic and clinical experience, of course there's a risk of inappropriate prescribing such as unnecessary antibiotic use and a greater chance of drug side effects in the context of multimorbidities and polypharmacy. This is particularly relevant for Aboriginal and Torres Strait Islander people, who often experience multiple health conditions earlier in life, and for older Australians, who are often on multiple medications. Other recent concerns include the increasing use of telehealth and emerging online business models often focused on prescribing specific substances like medicinal cannabis or weight loss drugs like Wegovy and Ozempic. In that context, prescribing is often based on a single phone or video consultation, so it carries much greater risks than those associated with typical face-to-face consultations with a GP who knows their patient.

Concerns have also been raised by stakeholders regarding the types of medications that can be prescribed by RNs. Specifically, the AMA and RCGP have expressed appropriate concerns around the prescribing of schedule 8 medications such as morphine and other opiates. Schedule 8 medications carry a significant risk of abuse, dependency and harm. It's my belief that prescribing of these should remain the role of the clinician ultimately responsible for patient care and management. There are real concerns not only for patients but also for prescribers with allowing nurses to prescribe schedule 8 medications without putting in place the appropriate legislative guardrails. For example, such designated RN practitioner prescribers will not necessarily have access to real-time monitoring programs, which is a real concern given the significant risk of misuse by some individuals of schedule 8 opiates.

The expansion of scope of practice should empower our healthcare professionals. It should improve accessibility and efficiency in health care. Our first priority should always be patient safety and the protection of patient care. Given the increasing complexity of medical care in this country, particularly for older Australians and for those with multiple medical problems, the best model of care is that provided in a multidisciplinary team. I support this bill as I support increasing the scope of practice of all competent healthcare professionals in Australia, but I call on the government to ensure that these changes are appropriately scrutinised and monitored and then not instituted in a kind of band-aid solution in response to the—at this point—unaddressed issue of our chronic healthcare workforce deficiencies. Having said that, I commend the bill to the House.

See this speech in context