Sophie Scamps (Mackellar, Independent) Share this | Hansard source

by leave—I move amendments (1) to (4) as circulated in my name together:

(1) Schedule 1, item 11, page 5 (lines 7 to 11), omit subsection 84AAM(4), substitute:

(4) The requirements determined under subsection (3) must include the following:

(a) a requirement to hold particular qualifications in nursing;

(b) a requirement to have particular experience in nursing;

(c) a requirement to be endorsed by a particular body.

(2) Schedule 1, item 11, page 5 (line 17), after "The approval is subject to", insert "the condition that the eligible nurse prescriber does not prescribe Therapeutic Goods Administration Schedule 8 medications and".

(3) Schedule 1, item 11, page 6 (after line 11), after section 84AAN, insert:

84AANA Additional requirements for authorised nurse prescribers

(1) The Minister may, by legislative instrument, determine requirements that authorised nurse prescribers must meet.

(2) The requirements may relate to:

(a) participating in relevant real time prescription monitoring; or

(b) making contributions to the National Medicines Record.

(4) Schedule 1, item 11, page 6 (line 28), at the end of subsection 84AAP(1), add:

; or (e) has failed to meet a requirement determined under section 84AANA.

I wholeheartedly support the intention of this bill, as it responds to a clear need to improve access to Pharmaceutical Benefits Scheme medications, ease workforce pressures and provide better access to health care for people living in rural and remote areas of Australia. However, serious concerns have been raised by key medical professional bodies regarding elements of this legislation. The amendments I have moved today seek to address those concerns.

Both the Royal Australian College of General Practitioners and the Australian Medical Association have expressed strong reservations about the bill in its current form. Their concerns go directly to whether the framework provides adequate protections for patients. Specifically, these amendments address three main concerns, including, firstly, that designated nurse prescribers should not be permitted to prescribe schedule 8 medicines, otherwise known as drugs of addiction, under the Pharmaceutical Benefits Scheme; secondly, that there is currently no requirement for an eligible nurse prescriber to participate in real-time prescription monitoring or to contribute to the national medicines record; and, thirdly, that, unamended, the bill allows the minister to determine eligibility as a nurse prescriber by reference to one or more professional requirements, rather than requiring that all relevant clinical and professional standards be met.

The amendments I'm moving today will do three things. Firstly, they specify that designated nurse prescribers cannot prescribe schedule 8 medicines under the PBS, making this a condition on the minister's power under section 84AA. This is a strong recommendation of both the RACGP and the AMA. Schedule 8 medicines are classified as controlled drugs and include opioids such as morphine, oxycodone and fentanyl, which carry a high potential for misuse, dependence, addiction and harm. These drugs are subject to strict regulatory controls. Nurse practitioners are authorised health practitioners within collaborative prescribing frameworks. However, they do not possess the same depth or breadth of training as medical practitioners. Training in pharmacology, diagnostics, interpretation of test results and ongoing medication monitoring differs significantly between nurse practitioners and general practitioners. For this reason, the range of medicines that may be prescribed by nurse practitioners or nurse prescribers must be carefully balanced to ensure prescribing remains safe and appropriate. Given the high misuse potential associated with controlled drugs and the risk of increased fragmentation of care, schedule 8 medicines—the most dangerous and addictive drugs—should be excluded from the list of medicines that nurse practitioners can prescribe under the Pharmaceutical Benefits Scheme. These amendments would do just that.

Secondly, these amendments require that all the professional conduct attributes listed in section 84AAM form part of the definition of an eligible nurse prescriber. As the bill is currently drafted, the minister may determine eligibility by reference to one or more of these attributes. However, professional medical bodies would reasonably expect all nurse prescribers to meet all these requirements as a matter of course, including holding particular qualifications in nursing, having particular experience in nursing and being endorsed by a specified professional body.

Thirdly, the amendments add further safeguards by requiring nurse prescribers to participate in relevant real-time prescription monitoring systems and to make contributions to the national medicines record. Real-time prescription monitoring plays a critical role in identifying and preventing prescription misuse, prescriber shopping and unsafe combinations of medications, particularly where controlled drugs are involved.

These amendments respond directly to the concerns raised by professional medical bodies and ensure that any expansion of prescribing authority under the bill is balanced by robust and appropriate safeguards. Of course, it must be made easier and more affordable for people to access the prescriptions and treatments they need; equity of access to health care is an essential goal. However, it is also essential that we do not cause unintended harm by undermining patient safety. We must ensure we maintain a safe, strong and well-regulated medical system.

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