Anne Webster (Mallee, National Party, Shadow Minister for Regional Development, Local Government and Territories) Share this | Hansard source

I move:

(1) Schedule 1, page 12 (after line 4), at the end of the Schedule, add:

37 Application of amendments

(1) The amendments made by this Schedule apply only if a declaration under subitem (2) is in force.

(2) The Minister may, by notifiable instrument, declare that the amendments made by this Schedule apply on and after a day, or throughout a period, specified in the declaration.

(3) However, the Minister may make a declaration under subitem (2) only if:

(a) a trial of nurse prescriber treatments (within the meaning of the National Health Act 1953) is conducted in at least one State or Territory; and

(b) after the end of the trial, the Nursing and Midwifery Board of Australia conducts a review of the trial; and

(c) the review demonstrates a suitably supportive evidence base for the safety and effectiveness of the amendments made by this Schedule.

I rise to speak to the amendment circulated in my name to the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. This bill seeks to enable eligibility for PBS rebates for medications prescribed by a new category of prescribers, 'authorised registered nurse prescribers'. It acknowledges the essential role nurses play in our health system, especially in the regions, and the important work they do. It also acknowledges that nurses are the largest component of the health system and the most well-distributed workforce in regional Australia.

The Nationals want to see improved access to health care and progress for the nursing profession and for multidisciplinary care more generally. However, I am moving an amendment because implementation of new policy must have appropriate testing to ensure it is safe, effective and won't have unintended consequences. The Nationals have two key concerns. The bill is not evidence based, as it fails to follow normal processes where testing of any new model of care occurs in a state or territory in Australia prior to the application of PBS rebates, and this bill does not have a funding model to enable registered nurse prescribers to work in primary care as no funding model or structure has been developed. It is important to differentiate the new RN prescriber model from existing master's qualified nurse practitioners who are autonomous prescribers.

My amendment is that this legislation should not be enacted until there has been a trial or pilot of this new model of nurse prescribing in a state or territory which is then reviewed by the Nursing and Midwifery Board of Australia to ensure suitability and a supportive evidence base for safety and effectiveness of the model. This is about following due process, ensuring accountability and transparency for Australian consumers and making good use of Commonwealth funds. There must be clear evidence that any new model of nurse prescribing will improve access to high-quality care, especially in the regions, and will not have negative unintended consequences for patient safety or continuity of care. RN nurse prescribers will still require an autonomous prescriber in primary care, such as a GP or a nurse practitioner, to oversee that prescriber. The problem is that there are not enough GPs or nurse practitioners in the regions now. How is this going to work?

The process of a nurse practitioner gaining PBS access was debated in the late 2000s, and nurse practitioners had already been prescribing under state and territory law for many years from the mid- to late-1990s. Governments, therefore, had real world prescribing data, independent evaluations, patient outcome studies and safety audits. These formed the evidence base for Commonwealth reform which enabled PBS access to commence from 2010, though restricted. Major reforms to PBS access for nurse practitioners have occurred only very recently. PBS access for nurse practitioners was based on extensive safety and effectiveness evidence in states and territories. That evidence was synthesised nationally. It directly informed the Commonwealth's decision to grant PBS access in 2010. PBS access was therefore an evidence based policy decision, not simply a political concession. While it arguably took many years too long, PBS access for nurse practitioners was a thoroughly evidence based policy decision, and this amendment seeks that the same evidence base be produced before implementation of the bill currently under consideration. I urge the House to support this amendment.

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