Ali France (Dickson, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. The Albanese Labor government is committed to strengthening Medicare and building a stronger, fairer healthcare system so that all Australians can access the care that they need. Australians rightly expect that Medicare will be there for them when they need it, no matter where they live or how much they earn. Yet an ageing population, rising rates of chronic and complex disease and workforce shortages, particularly in regional and rural and remote areas, are making it harder for people to get the right care at the right time. 50 per cent of Australians have at least one chronic health condition, such as diabetes, cancer, heart disease, Alzheimer's, endometriosis, motor neurone disease, Crohn's disease and dementia, just to name a few. And they're more likely to be women.

For people living with a chronic illness, access to affordable health care is life or death. Managing that illness is never-ending, often exhausting, expensive, frustrating and all-consuming. It often means the loss of work, poverty and a breakdown in relationships. It's a huge struggle. Part of that struggle can be delays in accessing GPS and specialists. Some simply can't afford the appointment, and others are on a waitlist. We know this is a direct result of a decade of underinvestment in Medicare by those two unhappy groups opposite formerly known as the coalition—a decade of turning a blind eye to the rising costs of health care and health inequality.

Since 2022, Labor has been squarely focused on fixing Medicare. In the 2025-26 budget, we made the single biggest investment in Medicare since it was established over 40 years ago: an $8.5 billion investment to expand bulk-billing for more urgent care clinics, to undertake the biggest GP training program ever, for hundreds of nurse scholarships, for cheaper medicines and for our women's health package. This investment is why I got involved in politics. It is why I wanted to represent the people of Dickson. Labor's record investment restores the $8.3 billion that the Australian Medical Association, the AMA, says was cut from Medicare under those opposite in a decade-long effort to dismantle Medicare by the Liberal and National parties of Australia, a calculated and sustained attack on bulk-billing. That decade cost us all, and we are now rebuilding.

This bill is a part of that rebuild. This bill will make life a little bit easier for all Aussies but in particular for those with chronic health conditions. These changes will empower nurses to work to their full scope of practice and improve access to medicines across the country. It enables suitably qualified, endorsed registered nurses to prescribe specified PBS medicines under a carefully designed, nationally consistent framework. Nurses will be able to provide safe, high-quality care, reducing the need for GP appointments for routine repeat scripts or a trip to A&E. We want to remove the barriers to regular and follow-up prescriptions. Registered nurses make up approximately half of the country's health workforce and are the most geographically distributed health profession. This is particularly true in my state of Queensland. More than half of our population lives outside Greater Brisbane. In many communities, the kilometres to the nearest GP and then the nearest chemist are the barrier. In many Queensland communities, nurses are the first point of contact and the most consistent presence in a person's health journey. This is the case across aged-care facilities, community clinics, Indigenous health services and outreach programs. This bill acknowledges that reality and provides a safe pathway for designated registered nurse prescribers to keep people well closer to home.

For a relative in an aged-care home, this might mean a timely dose adjustment can be made and dispensed under the PBS by the authorised nurse practitioner working in partnership with their GP. For a family in Central Queensland, it might mean not having to take a day off work or drive hundreds of kilometres for a simple routine repeat prescription. This is how we make Medicare work for real people—by removing barriers and supporting the teams already caring for people in our communities. Harnessing the strength of our wonderful nurses will improve access to essential medicines, support continuity of care and take pressure off our healthcare system.

These new laws come after extensive research, development and consultation led by the Nursing and Midwifery Board of Australia and the Australian Chief Nursing and Midwifery Officer. These changes include safeguards to ensure the best level of care. Only registered nurses who meet the registration standard for designated registered nurse prescribers through specific education, competency and professional requirements will be eligible to apply for PBS approval. This bill outlines a framework that is collaborative, safe and accountable to deliver access without compromising standards.

This bill is part of the Albanese Labor government's commitment to strengthen Medicare. We have delivered more bulk-billing GPS by significantly increasing the bulk-billing incentive, supporting more practices to bulk bill and making it cheaper to see a doctor. We are opening more Medicare urgent care clinics so families can get urgent non-life threatening care without having to go to the emergency department and without a bill. The Murrumba Downs urgent care clinic in my electorate has treated over 27,000 people. The staff is incredible, and the community absolutely loves this service.

We've made PBS medicines cheaper by reducing the maximum cost of PBS medicines from $31.60 to just $25. The last time they were this low was in 2004. We introduced 60-day scripts, halving the number of pharmacy and GP visits needed for repeat scripts. We are modernising digital health, strengthening e-prescribing, enhancing My Health Record and improving secure messaging so the right to information is available to the right clinician at the right time. We are investing in our health workforce. We're hiring more doctors and nurses, expanding training pathways, and, as I mentioned before, we're undertaking the biggest GP training program across the country that has ever been undertaken. We want to grow our next generation of GPS. We want to see more GPS in our communities and particularly in regional, rural and remote communities.

We are investing more than $790 million in women's health—something I'm incredibly passionate about and, as I'm in my menopause era, I'm actually taking advantage of. We're making contraceptives cheaper. We're expanding access to treatments for menopause. We're making access to endometriosis specialists and getting specialist support for complex gynaecological conditions right across the country. This is long overdue, but we're delivering it. We're opening endometriosis and pelvic pain clinics right across the country so that women can get earlier diagnosis and better treatment.

We are delivering more free mental health services, with walk-in Medicare mental health clinics popping up right across the country. We opened one in my electorate, in Strathpine, last year. The feedback from that service has been incredible, particularly from local families, who say that, instead of having to go to the A&E if their relative or loved one is having a mental health crisis, they can now pop down to the Strathpine Medicare mental health centre. No appointment is necessary. It's walk in. We will continue to listen to patients, nurses, doctors, pharmacists and community leaders because good policy is co-designed with the people who use it and deliver it.

Medicare is Labor's heart. It is the very best of this country and it is dearly loved by all Australians. That is why we are working to strengthen and protect it and why this bill matters so much. The Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025 is a practical, safety-first measure to improve access, strengthen teams and modernise care. It recognises the central role nurses play in communities across Australia. I stand here in absolute awe of the nurses that I have been in contact with in my health journey. They are an incredible support to so many people across our community. I have always had the most amazing care from our nurses in Queensland and New South Wales. Together with our wider Medicare reforms, this bill helps deliver a stronger Medicare and a more resilient, equitable health system for every Australian. I commend the bill to the House.

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

The Prime Minister has been at pains to tell us repeatedly that the only card that we need take to a medical appointment is the Medicare card. He's told us that the Labor government's changes to incentivise bulk-billing would make primary health care free to all those who need it. But across Mallee my constituents are lucky if they can get an appointment with a GP at all, let alone not pay a gap fee. The average GP gap fee, or out-of-pocket cost, is now over $50. The national out-of-pocket GP costs have more than doubled, from $780 million in 2021-22 to $1.66 billion in 2023-24. Out-of-pocket costs have risen steadily across all socioeconomic areas according to the Australian Institute of Health and Welfare. Bulk-billing, under the coalition, was at 88.9 per cent in 2021. Despite Labor rhetoric, it has fallen. In 2024-25, the latest figures, it was 77.6 per cent. That's an 11 per cent drop in bulk-billing. The fact is remote, outer regional and inner regional areas have lower bulk-billing rates than major cities. So your Medicare card is not all that you need, Prime Minister. That is another fabrication from this arrogant and secretive Labor government. This is a government that is all about the headline or the catchy three-second hook on social media to halt the doomscroll but not so much about doing the hard yards and policy grunt work to make lasting change.

The Nationals' perspective on health care, the Mallee experience—when I asked my electorate of Mallee late last year about their biggest concerns, I received more than 5,300 responses, with Mallee residents telling me their No. 1 priority was better hospitals and access to health care. When asked about primary health care, the top concern of my constituents was wait times to see a doctor, followed by out-of-pocket costs and then wait times to see allied health professionals. Health care access and affordability is front of mind for my constituents and regional Australians more broadly. But this Labor government is forever letting them down and putting their needs out of sight and out of mind. The Nationals want to rectify the poorer health status of regional Australians, a status driven in large part by poorer access to health services. Rural and remote Australians have higher morbidity and mortality rates than those in major cities. This is a known fact. In very remote areas potentially avoidable deaths are 2.8 times higher than in major cities. Rural Australians receive less service delivery per capita despite higher need and worse outcomes. How is this okay? This Labor government promised to govern for all Australians, but clearly they are not for rural Australians.

The National Rural Health Alliance published a study in August last year which showed that less money is being spent per person in rural and remote regions than in the city. In 2021, the spend was $848 less per person than for city people. But it gets worse. The latest available data suggests that this underspend has blown out to over $1,000 per person in regional and remote areas. Poorer health access is driven in large part by the lack of health workforce in the regions. Here are the facts. In 2023, small rural towns had the lowest number of GPs and specialists per capita. But it's not just GPs and specialists. Small rural towns also have less than half the allied health workforce per capita that major cities have. The Nationals are committed to supporting regional communities and driving policies and programs that will improve the health status of regional Australians.

In the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025, the Labor government says it is trying to address healthcare accessibility issues due to workforce challenges by expanding the scope of practice of registered nurses. Nurses are the largest component of the health workforce in Australia. There were 329,000 registered nurses in 2024 compared to 122,000 doctors, making up just over 44 per cent of the total health workforce. There are more nurses in small rural towns, remote areas and very remote areas than any other kind of practitioner. It is great to focus on and support nurses. I have a daughter who is a nurse. We know they do wonderful work and they are the bedrock of our health system.

The problem with this bill is that having a new category of nurse, nurse prescribers, provide pharmaceutical benefit schedules is not evidence based. It's not evidence based policy making nor is it addressing the core issues driving poor access to health care and core health outcomes, particularly in regional Australia. This is lazy policy making, driven by this government's blind allegiance to Labor state governments with abysmal fiscal restraint and failing health systems who, no doubt, want to employ authorised nurse prescribers in urgent care clinics in cities and larger regional centres. Labor are seeking quick wins with little effort to address policy complexity.

What will this bill seek to do? It seeks to grant eligibility for Pharmaceutical Benefits Scheme rebates on medications prescribed by a new category of prescribers—authorised nurse prescribers. The government's proposed authorised nurse prescribers will be registered nurses with additional training who work in a collaborative arrangement with an autonomous prescriber, a professional who can already prescribe independently. Now, that means GPs and nurse practitioners.

Our position as the Nationals on this bill is cautious. We are cautious about the legislation due to the lack of real world testing of this model in Australia and, therefore, the lack of robust evidence. Applications for registered nurses to become endorsed for prescribing were only declared open last month via the Nursing and Midwifery Board of Australia under national law. The first prescribers are anticipated under this new arrangement from mid-2026—so we're talking July onwards—but require additional changes to state and territory laws.

I want to point out, though, that the usual process is that states or territories run a trial or a pilot first on a new prescribing model without PBS eligibility, to ensure the model is tested and safe. A state or territory trial has not happened. Therefore, the clinical governance, safety and responsibility framework of this new system is untested. It needs to be tested before it is supported by Commonwealth taxpayer funds.

I also want to highlight that the time difference between endorsement for prescribing and PBS rebate access has generally been lengthy for other prescriber groups, so who knows when nurse prescribers will be able to prescribe with PBS rebates. A pilot program should occur within a state or territory without PBS rebates before national rollout of PBS rebates. That is a responsible approach that this government just has not looked at.

Secondly, there is currently no funding mechanism to adequately remunerate these authorised nurse prescribers in primary care settings, which is where they are actually needed. Medicare does not currently fund this approach, and the Workforce Incentive Program, commonly known as WIP, and the Practice Incentive program, PIP, are not adequate or appropriate to fund this model of care. If registered nurses who have engaged in additional study to gain endorsement for prescribing cannot be appropriately remunerated, they will not work in primary health settings. If the services of authorised nurse prescribers are not affordable—in other words, if people have to pay out of pocket—patients simply won't seek them out. Funding mechanisms for this proposed model need to be determined and tested before PBS eligibility is rolled out. This bill is putting the horse before the cart. Who would have thought?

Thirdly, the Nationals are sceptical because this bill does not address key drivers of poor access to health care and health status in the regions, including the lack of a primary healthcare workforce with the ability to prescribe autonomously—that is, GPs and nurse practitioners who will oversee the work of authorised nurse prescribers. If you don't have enough GPs and you don't have enough nurse practitioners out in the regions, how is this program actually going to benefit the regions? I would argue it won't.

The funding models do not adequately meet the financial pressures of primary health care in the regions or facilitate the provision of multidisciplinary care. We're talking about block funding. ACCHOs and NACCHOs have block funding. The only way that this government can ensure that this rollout will work is under a state funded basis, under public health. I don't think Australians want to have their choice removed. And so the funding mechanism itself must be sorted out, along with the governance of this program.

Fourthly, this legislation risks adding to the workload of the limited primary healthcare workforce in regional Australia, adding strain rather than bringing in and training up a workforce who can autonomously assess, diagnose and treat with medications on its own. This negative unintended consequence has not been considered.

The Albanese Labor government has made repeated decisions that disadvantage regional Australians when it comes to health care, especially primary health care, including changing the Distribution Priority Area rules that govern where overseas doctors have to work when they come to Australia, making it possible for them to choose to work in metropolitan areas and large regional centres at the expense of rural and remote areas. This was the very first decision that the Minister for Health made, funnelling excessive amounts of money into inefficient and costly urgent care centres in metropolitan areas and large regional centres but unwilling to address the specific needs of rural towns and remote areas, who are rarely served by these clinics. It is a metro-centric approach—make no mistake.

The Labor government has also failed to tackle the desperate need for complex funding change in primary health care in regional Australia that would incentivise the provision of multidisciplinary health care in small rural towns and remote areas and appropriately address the higher cost of providing care in these regions. They are failing to address a need and evidence base for end-to-end training of medical and other health professionals in the regions to grow our own workforce.

In conclusion, the Nationals are all for positive changes in our health system that will improve access to high-quality care when and where people need it. I acknowledge the essential role nurses play in our health system, especially in our regions, and the very, very important work that they do. But I will always advocate for evidence based policy that is set up to succeed and to address the core issues that my constituents are concerned about. This bill is lazy. It is politically driven policy that does not address the root causes of the problems in our health system. It has not been tested and is being set up to fail.

Ash Ambihaipahar (Barton, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. This is a bill that goes to the heart of how we deliver health care in this country, who we trust, how we use our workforce, and whether Australians can access the medicines they need when they need them without unnecessary delay or cost. This bill is more than a legislative amendment; it is absolutely about modernising our health system in a way that reflects reality on the ground. It is about recognising the skill, training and professionalism of nurses, and it is also about ensuring Medicare continues to serve Australians not just for today but into the future.

This reform matters because Australia's health system is facing pressures that are both known and deeply felt by communities across the country. We have an ageing population. We are seeing higher rates of chronic and complex disease. Demand for primary and acute care continues to rise while workforce shortages—particularly in general practice, aged care and rural and remote services—place real strain on patients and providers alike. For too many Australians, accessing health care has become more difficult than it should be. We know people are waiting longer for appointments. Emergency departments are under pressure, and in some communities people are travelling long distances or delaying care altogether. If we are serious about strengthening Medicare then we must look honestly at how our health system operates and how it can operate better. That means using the skills we already have in our workforce more effectively.

Before coming into this place, I worked closely with the New South Wales Nurses & Midwives' Association. In that role, I had the privilege of listening to nurses from every corner of our health system, whether it was in the public or private system, in metro hospitals or regional clinics, or in aged-care facilities or community health services. I witnessed their pride in their professionalism, their commitment to patient care and their willingness to step up, often in incredibly challenging times. But I also heard their frustration. I heard from nurses who knew exactly what their patients needed but were constantly constrained by systems that no longer made sense. I heard from nurses who were trusted to manage complex clinical situations but could not take the final step of prescribing a medicine—even when it was safe, appropriate and well within their competence.

I had the opportunity to listen last night to the contribution of the member of Indi on this piece of legislation. I, too, heard about nurses who spent hours chasing signatures, making phone calls and sending patients elsewhere for tasks that they could have easily resolved, quickly and safely, in the same consultation. I heard from patients, particularly older Australians and people living with chronic illnesses, who bore the cost of that inefficiency in delays, inconvenience and sometimes worsening health conditions. This bill responds directly to those experiences. It reflects what nurses have been saying for many years, that with the right training, safeguards and collaboration they can do more and patients would be better off for it.

Registered nurses make up about half of the Australian health workforce. They are the pillar of our health system, delivering care across hospitals, general practice, aged care, disability services, community health and beyond. They are also the most geographically dispersed health professionals in the country. In many rural, regional and remote communities, nurses are not just part of the health system; they are literally the health system. Nurses are highly educated and highly regulated but also deeply trusted by the public of Australia. Yet, despite this, their scope of practice has not always kept pace with their training or the needs of patients. This bill takes a sensible step towards addressing that imbalance.

The Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025 makes targeted amendments to two key pieces of legislation. First, it amends the National Health Act 1953 to allow registered nurses who are endorsed under the relevant registration standard to become authorised prescribers of certain medicines under the Pharmaceutical Benefits Scheme. This means that when those nurses prescribe approved medicines, patients can access them at PBS subsidised prices, ensuring affordability and equity.

Second, the bill amends the Health Insurance Act 1973 to ensure that prescribing services provided by designated registered nurse prescribers are subject to the Professional Services Review scheme. This ensures that strong oversight, accountability and safeguards remain in place, protecting patients, taxpayers and the integrity of Medicare. This is not a radical change; it is a carefully designed reform that modernises our legislation to reflect contemporary healthcare practice.

It is also important to be clear about what this reform is and what it is not. This bill does not create unsupervised prescribing. It does not lower standards. And it does not compromise patient safety. I had the opportunity to also listen to the contribution made by the member for Mallee, who was making rather bold assertions about this particular policy. She referred to it as being 'lazy', that it doesn't have enough evidence. Assigned registered nurse prescribing is the result of years of extensive research, consultation and policy development led by the Nursing and Midwifery Board of Australia in collaboration with the Australian Chief Nursing and Midwifery Officer.

In December 2024, all Commonwealth, state and territory health ministers approved a new national registration standard endorsement for scheduled medicines designated registered nurse prescriber. That standard came into effect in September 2025. Under the standard, registered nurses must meet strict education, experience and competency requirements to gain and maintain endorsement. Prescribing must occur within an agreed scope and under a formal prescribing agreement with another authorised health practitioner. This is collaboration. This is team based care. This is the gold standard of modern health delivery.

The first cohort of designated registered nurse prescribers is expected to complete their education, receive endorsement and commence prescribing from July 2026. This phased approach ensures the workforce is well-prepared, systems are ready and patient safety remains paramount.

For patients, the benefits of this reform are real and immediate. It means quicker access to medicines for common and ongoing conditions. It means fewer unnecessary appointments simply to obtain a prescription. It means less pressure on overstretched general practices and emergency departments. It also means care that is delivered closer to home.

For the people living in rural, regional and remote areas this reform is very important. In many communities, access to a GP can involve long travel times and extended waits. Enabling appropriately endorsed nurses to prescribe certain medicines allows people to receive care locally, safely and affordably. This is about fairness. Where you live should not determine how easily you can access essential medicines.

This reform aligns directly with the work of the Strengthening Medicare Taskforce and the Unleashing the potential of our health workforce: scopeofpracticereview. It recognises that workforce reform is essential to the long-term sustainability of Medicare. By allowing nurses to work to their full scope of practice, we improve efficiency across the system, reduce duplication and ensure that all health professionals can focus on the areas where they add the most value. This is not about replacing doctors or diminishing any other profession. It is about using the full health team efficiently and effectively so patients receive the right care from the right professional at the right time.

The bill ensures that medicines prescribed by designated registered nurse prescribers under the PBS remain subject to the same rigorous processes that apply to other prescribers. The Pharmaceutical Benefits Advisory Committee will continue to assess which medicines are appropriate for prescribing under this model, ensuring decisions remain evidence based and cost effective. This protects the integrity of the PBS while expanding access for patients.

For nurses, this bill represents recognition: recognition of their education, recognition of their clinical judgement and recognition of the role they play in our society by delivering high care to all Australians every day. Having worked alongside nurses through the New South Wales Nurses and Midwives' Association, I know how deeply this recognition matters. It's not about status. It is about being trusted to do the job they are trained to do—in partnership with others and in the best interests of the Australian people.

This bill delivers on the Albanese government's commitment to strengthen Medicare, support our health workforce and improve access to affordable medicines. It empowers nurses, it supports patients and it builds a health system that is more responsive, more equitable and more sustainable. This is sensible reform, it is patient focused reform, and it is reform that reflects the realities of modern healthcare in Australia. I commend the bill to the House.

Michael McCormack (Riverina, National Party) Share this | Link to this | Hansard source

We should thank our nurses each and every day—not only our nurses but our pharmacists and our doctors. Anyone who puts on scrubs and goes into a theatre ward and anyone who serves our hospital system or our medical system needs the applause and the gratitude of this place and of Australians right across the nation.

I'm one who listens very carefully in question time. This government is now nearly four years old. For four years, the Labor government has been blaming the Morrison-McCormack government in particular and previous coalition governments per se for the financial stresses it claims it's under. They exaggerate the figure. Yes, we did have a debt, that debt born out of a global pandemic the likes of which we had not seen since just after World War I—which, of course, ended in 1918. We did what we could. We spent the money that was needed to keep people in jobs and, more importantly, to keep Australians alive—not just Australians but our Pacific neighbours and friends as well.

Through those Morrison years, there were more than 94 million telehealth consultations through Medicare, with 16 million patients, and that was a significant achievement. Speaking as one who comes from rural and regional Australia, we don't ever want to see telehealth replace hands-on medical professional care. It was necessary during the COVID years and it's necessary at any time, but, particularly in remote Australia and in Indigenous communities, we don't want to see telehealth replace a person who can give a consult. During the Morrison years, from 2019, 857 new medicines were listed on the Pharmaceutical Benefits Scheme—another significant achievement. There were 1,400 additional nurse placements for the regions, and that is something that we should also be very proud of as a former coalition government.

The Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025 is about empowering nurses. The bill worries me as one who comes from the regions and as one who wants to see nurses being the best they can be, just like pharmacists were, and we empowered those during the COVID crisis, when it seemed that the AMA, the Australian Medical Association, wanted only doctors to issue vaccinations when we knew that in some rural communities the only health professional in town was a chemist. That chemist needed to be able to issue vaccines as well. It just made good sense. And the member for Barton, in her contribution, talked about the fact that in some regional communities a nurse is the only health professional in town, and she's right. Sadly, she's very accurate.

But, as the member for Mallee quite correctly pointed out in her earlier speech, the first order of business of this federal Labor government in the medical field was to change the distribution priority areas. That saw doctors operating in some regional communities take their shingle from the wall and move to Newcastle or Wollongong or the Gold Coast or anywhere but regional and remote Australia, and this was wrong. They were making money. They were providing a level of health care second to none, but they saw the opportunity to move to the coast and did so, and good luck to them. But as the national rural health reporter Steven Schubert of the ABC wrote in an article from 15 December 2022 headlined 'Rural doctors say they are losing staff to big cities due to policy change':

Annette Pham thought she had recruited two doctors to work in her GP clinics, but a policy change in Canberra resulted in both of them pulling out almost overnight.

Ms Pham and her husband own four GP clinics on the New South Wales south coast, all within a few hours' drive from Sydney and on some of Australia's best beaches—

no question there. The article continues:

"We had two that pulled out officially after signing contracts," she said.

"Then we've had probably a further three that looked at our practice, they looked at other practices and they inevitably decided in the end that they would stay in the city."

That is a problem. The article also says:

Rural Doctors' Association of Australia (RDAA) chief executive Peta Rutherford said the organisation was getting reports the policy—

this is the distribution priority areas policy moving the boundaries such that it takes in those areas I mentioned before, Newcastle and Wollongong and the Gold Coast et cetera—

was going to have an impact on rural communities before it had even been implemented.

Well, if that was the fear before, it certainly ended up being a reality afterwards. And it is true that doctors took their practices and took themselves and moved to other areas of Australia, more populated areas of Australia, areas of Australia where there are more doctors. Unfortunately—and I don't blame them; I blame the government—what this policy meant was that regional areas and some particularly remote areas then got left high and dry as far as doctors were concerned.

I also will recall the health minister talking about bulk-billing rates, which we know, because it was quoted so many times in the House of Representatives last year, dropped by 11 per cent under Labor to 77 per cent from the previous 88 per cent under the coalition. He was talking about rural people, and he said that if they can't get a doctor's appointment, they could pick up the phone and try another doctor. That might all be well and good in Adelaide, but it doesn't cut the mustard out in country towns because you're lucky to get a doctor bulk billing or otherwise. You're certainly lucky if you can get a bulk-billing doctor.

I know Labor will pat themselves on the back and say: 'Bulk-billing rates are something that is a priority. The GP aftercare clinics, the urgent care clinics—we're rolling them out across the country.' Yes, they are but in Labor electorates and in electorates that they want to win. We heard the member for Lyne talking about Taree, and I do hope Taree gets one of those care clinics because it's needed and not just in Taree but in many other regional communities as well. They are needed and they are good. I will acknowledge that they do fill the gaps of the state public health system and the overall medical system where people often do need, particularly after hours, to take babies and children when there is no other doctor available, and that is saving lives. I acknowledge that.

But what we are talking about here is nurses being given more scope to provide medicines to do what sometimes ordinarily would be the job of the local general practitioner. I do wonder what the AMA thinks of this. I know that a lot of the legislation that Labor is bringing to this place and has done since May 2022 is often rushed. There's often not the stakeholder engagement that you would expect in important nation-changing legislation, and that is something that truly troubles me.

I know that the member for Mallee, who happens to be married to a doctor, said that the Nationals—indeed, the Liberals too—want to rectify the poorer health status of regional Australians. I know that would be a goal as well of Labor members. Surely that's something that would be across the board. It's a status driven in large part by poor access to health services in the bush. Sadly, we people in country Australia don't live as long as those who live in metropolitan Australia who have closer, better and more diverse access to health services than those who live a long way from the city lights. We as a party, and I will say as parties of coalition, are committed to supporting regional communities and driving policies and programs to improve the health status of regional Australians. Again, I say that I know that would be a goal of Labor too. It would be silly to say it's not, but health has to come above politics. It truly does. I know when I entered this place in 2010, I was told by more than one person that if you get the health of your community right, it provides that happiness factor, that satisfaction factor, and everything else will seem to take care of itself. Indeed, that is the truth.

This bill seeks to grant eligibility for Pharmaceutical Benefits Scheme rebates on medications prescribed by a new category of prescribers, and they're called authorised nurse prescribers. As I understand, there will be training for those authorised nurse prescribers. Whether the training for six months is sufficient—I'm certainly not in any way, shape or form denigrating those nurses and the work that those nurses perform, whether they are young, freshly out of the system and straight into the hospitals, the practices or the clinics or whether they have been there for decades. I certainly do not in any way put criticism on what they do because the care of their patients is first and foremost.

The government's proposed authorised nurse prescribers will be registered nurses with additional training who work in a collaborative arrangement with an autonomous prescriber professional who can already prescribe independently, expanding the scope of practice for a registered nurse. Labor is proposing this new model of prescribing in Australia. Nurses who meet these criteria are not expected to be qualified to prescribe until the middle of 2026, but that's only less than six months away. That's not far away in the scheme of things. So I do wonder and I do question, as with much of what Labor introduces, whether it's policy on the run, whether it masks a more serious situation—and that is the lack of doctors practising in Australia. I would like to think that Labor would not be using this as a trojan horse to not then provide the necessary funding, ongoing support, for such things as the medical schools.

I will say that the Murray-Darling Medical School Network is going tremendously well. I know that in Wagga Wagga, in Bendigo, in Mildura, in Shepparton, in Dubbo and in Orange it is actually answering and fulfilling a need that was there. I'm so glad that I was able to, with former health minister Greg Hunt, fund that vital network of services which are provided in just about every town and city. The former minister for education is now taking the credit, and he played a part too, so I do thank the member for Wannon. It was a coalition initiative. Indeed, every one of those facilities, in every one of those centres I mentioned, is producing 20 to 30 new doctors—well, they will be when the doctors graduate; of course we know that takes some years. It certainly started under the coalition government. I know that Mike Freelander, the member for Macarthur, came and opened the one at Wagga Wagga late last year and gave some generous words. He knows that we need to be more bipartisan when it comes to health, because health is everything.

There are some conditions and there are some parts of this legislation which do worry me. I know the member for Mallee has set out her concerns, and I know that each and every regional member would also, understandably, share some of those issues that this legislation has in it.

Renee Coffey (Griffith, Australian Labor Party) Share this | Link to this | Hansard source

Griffith is home to one of the busiest health precincts in the country, and our workforce numbers reflect that, with more than 16½ thousand healthcare and social assistance workers across my electorate—the fourth highest in the country by percentage. Griffith is also home to some of Queensland's and our country's most important hospitals. The Princess Alexandra Hospital is a major teaching and research hospital, leading in major trauma care and home to Queensland's specialist adult spinal injuries rehabilitation unit. The Mater Hospital is a leader in obstetrics and provides specialist neonatal intensive care for some of our tiniest and sickest babies. I would like to shout out the Mater Foundation and also the work of the Mater Little Miracles. The Queensland Children's Hospital delivers specialist health services and care for kids and young people from right across the country, and our community also relies on the high-quality care and treatment provided by Greenslopes Private Hospital and St Vincent's private hospital.

So, when we talk about strengthening Medicare, improving access to care and pursuing better health outcomes, Griffith is not watching from the sidelines. We are living it, we are staffing it and we are relying on it. But we also see the strain. We see it in how hard it can be to get a timely appointment in primary care. We see it in the pressure on emergency departments when people cannot get the right care early. We see it in aged care, where clinicians are working to keep residents stable, comfortable and safe. But the system can still create delays for matters that should be straightforward.

The Albanese government made an election commitment to prioritise scope-of-practice reforms for health professionals because we know these reforms deliver real benefits to Australian patients through improved access to health care. This bill, the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025, is an important step in delivering on that commitment. It will help ensure Australians have better access to the affordable medicines they need when they need them, and it backs our registered nurses to deliver safe, high-quality care, particularly in primary care and aged care.

This bill does two things. First, it amends the National Health Act to allow registered nurses endorsed against the relevant registration standard to be authorised prescribers. This enables them to prescribe certain medicines that can be supplied under the Pharmaceutical Benefits Scheme and attract Commonwealth subsidy. That matters because the PBS is what makes medicines affordable for millions of Australians. If someone can receive the right prescription but cannot access it affordably, we are not improving health outcomes.

Second, it strengthens integrity by amending the Health Insurance Act so that registered nurses providing these prescribing services are included under the Professional Services Review Scheme. As a result, designated registered nurse prescribing under the PBS will be subject to the same peer review safeguards that protect Medicare and protect the PBS, reinforcing public confidence in a system that must always put safety first. Designated registered nurse prescribing enables safe, timely and effective prescribing by registered nurses, extending their scope of practice, particularly in primary care and aged-care settings.

This reform builds on careful design and consultation already taken right across the sector. In December 2024, health ministers approved a new registration standard that allows suitably qualified registered nurses to become designated registered nurse prescribers. That standard took effect on 30 September last year. Importantly, the first cohort of designated registered nurse prescribers are expected to complete their education, receive endorsement and begin prescribing from July this year.

Our communities know when our health system is not keeping up. They experience it when a script needs renewal and the next available appointment is too far away. They experience it when an older person in aged care needs a timely medicines review. They experience it when someone is discharged from hospital and needs coordinated follow-up to stay well rather than ending right back in emergency once again.

In those settings, registered nurses are already doing extraordinary work: assessing, monitoring, educating, coordinating care and keeping people safe. But too often the system still forces extra steps, extra appointments and extra delays just to obtain a prescription, even where the care is already structured and the clinical pathway is clear. Designated registered nurse prescribing helps close that gap. It supports earlier, more seamless care, reduces avoidable waits and helps patients receive the right care in the right setting. And it supports affordability. By enabling PBS prescribing by authorised, appropriately endorsed registered nurses, this bill ensures the medicines they prescribe can attract Commonwealth subsidy and remain affordable for patients.

Expanding access must never mean compromising safety. This reform is designed around education, endorsement and governance. It is grounded in a registration standard approved by health ministers, and it operates within a defined scope, with safeguards around which medicines can be prescribed. The bill provides that the minister will determine which pharmaceutical benefits can be prescribed by authorised nurse prescribers and requires the minister to have regard to advice from the independent Pharmaceutical Benefits Advisory Committee. And, by bringing these prescribing services within the Professional Services Review Scheme, the bill strengthens accountability and protects the PBS.

This bill is also part of a broader, consistent agenda from this Labor government to strengthen Medicare, improve health outcomes and deliver real cost-of-living relief. That includes more free medicines and more cheaper medicines sooner, with a 25 per cent reduction in the number of scripts a concessional patient must fill before the PBS Safety Net kicks in; the largest cut to the cost of medicines—just $25 as of this year—in the history of the PBS; 60-day prescriptions, saving time and money for millions of Australians with an ongoing health condition, now covering more than 300 medicines; and freezing the cost of PBS medicines, with co-payments not rising with inflation, for all Australians for the first time in 25 years. And, with 1800MEDICARE, the Albanese government is making it easier for Australians to access healthcare when and where they need it.

I'm also proud that the new Medicare urgent care clinic in Coorparoo, which I have secured for our community, will open in the coming weeks. This is in addition to the new urgent care clinic we opened in Carina just 43 days ago, which joined the existing network of 16 urgent care clinics right across Queensland, including the South Brisbane urgent care clinic in Woolloongabba, which has been servicing our community for some time now. Ninety Medicare urgent care clinics are in operation across Australia, which have already seen more than 2.4 million presentations since the sites first opened in June 2023—including just under half a million presentations in Queensland alone.

It was a Labor government that built Medicare, and it is only a Labor government who will continue to protect and strengthen Medicare. When medicines are cheaper, families feel that relief immediately. When the system enables the health workforce to operate effectively, patients receive care sooner and avoidable hospital presentations reduce.

I acknowledge the contribution of my good friend the Queensland state member for Greenslopes, Joe Kelly MP. Joe and I have known each other for many years now, and it's a joy to work closely together with him to support the constituents we jointly represent in that part of my electorate. Joe brings decades of nursing experience to public life, and he speaks about health care with the credibility that comes from having been there on the ward with patients alongside colleagues who carry the load day after day. I'm so honoured that I have colleagues here in the House who also bring such rich experience into this place.

Like some in elected positions, including in this place, Joe has stayed close to the front line so that his perspective stays grounded in the realities of care and the pressures our workforce is facing. When he talks about why scope-of-practice reform matters, he puts it very simply: 'Every time I do a shift, I work with caring, passionate, highly-qualified and skilled nurses with decades of experience. Supporting nurses to use their skills to the fullest extent will be fantastic for patients.' I have to say, that is typical Joe Kelly; his focus is always on patients, on the community and on constituents.

I could not agree more: this bill is about backing that skill, backing that experience and making it easier for Australians to get the care and medicines they need sooner, safely, affordably and closer to home. It reflects the direction identified through the Strengthening Medicare Taskforce and the work to unleash the potential of our health workforce, with patients at the very centre.

Kate Chaney (Curtin, Independent) Share this | Link to this | Hansard source

I rise to speak on the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. At its heart, this bill aims to improve access to health care and reduce costs by extending prescribing rights under the Pharmaceutical Benefits Scheme to authorised nurse practitioners. These changes recognise the essential role nurse practitioners already play across our health system, and I support the objective of improving accessible, affordable care.

In a country as vast and decentralised as Australia, geography too often dictates health outcomes. In rural, regional and remote areas, the closest GP may be hours away. For older Australians, people living with disability, First Nations communities and vulnerable people, the barriers to safe, timely and affordable care can be even higher. When a nurse practitioner is already providing frontline care, it's both logical and safe to allow them to prescribe medicines within a clearly defined scope.

While I support the intention of this bill, the success of these reforms will depend entirely on how the detail is implemented. Several stakeholders have highlighted that key elements, including approval conditions and scope of prescribing, are being left for future ministerial determinations. This means we're being asked to legislate a framework without yet seeing the guardrails that will govern it, and we're doing so before the Senate committee has delivered its report. This is not an ideal position for the parliament to be in and risks leaving questions unanswered for practitioners, patients and the broader health system.

There are two areas in particular that I want to highlight. First, the scope of medicines available for prescribing must be sensible and safe. This reform should focus on routine, low-risk and clinically appropriate medicines, not those that carry higher risks of dependency or misuse. Schedule 8 medicines, in particular, should fall outside this expanded authority. Our goal here is to improve access, not to create unintended consequences for patients or the health system. Doctors are best placed to make decisions about these schedule 8 medicines, which are used for severe pain or conditions like ADHD and include opioids such as morphine, stimulants such as dexamphetamine, cannabis and certain benzodiazepines. Our goal here is to appropriately improve access.

Second, the definition of 'authorised health practitioner' must be precise. Nurse practitioners play an invaluable role, but it should be absolutely clear that they will continue to practise within a collaborative, medically supported model of primary care. This is how high-quality care already functions and the regulations should reflect this reality. Ambiguity helps no-one, not practitioners, not regulators and not patients. These are not objections to the reform; they are a request for safeguards to ensure it delivers what it promises—better access without compromising safety or fragmenting care.

This bill has the potential to move us meaningfully towards a more equitable health system but only if the detail is done well. I urge the government to engage openly with the findings of the Senate committee, once available, and to ensure the regulations are transparent, evidence based and clear. Australians deserve a health system that's accessible, safe and equitable. This bill can contribute to that goal if we get the implementation of it right, and I'll continue to engage constructively with the government to ensure that that happens.

Trish Cook (Bullwinkel, Australian Labor Party) Share this | Link to this | Hansard source

I rise today to speak in strong support of the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. The Albanese Labor government is committed to supporting and empowering our health workforce. We are not just talking about strengthening Medicare; we are also doing the hard legislative work and structural reform to make health care more accessible for every Australian, and this bill is one piece of the structural reform puzzle in the healthcare sector. This bill addresses the scope of practice reforms for nurses and midwives. It is legislation that is catching up with healthcare demand and practice and it is backed by evidence and consultation.

Since 2017, the Nursing and Midwifery Board of Australia and the Australian Chief Nursing and Midwifery Officer have undertaken extensive research and consultation about the potential for registered nurses to contribute to improving health outcomes for the Australian community by supporting nurses and midwives to work at the full scope of their practice. Unleashing the potential of a health workforce scope of practice review was delivered to the government on 30 October 2024 after 12 months of consultation and research led by independent researcher Professor Mark McCormack. The review was clear. When health professionals work at the top of their scope, the entire system breathes more easily. It reduces the bottleneck at the GP's door and it allows our doctors to focus on the most complex, high-needs cases while endorsed nurses can manage stable chronic conditions within a clear framework.

In December 2024, Commonwealth, state and territory health ministers approved a new registration standard. It was called 'Endorsement for scheduled medicines—designated registered nurse prescriber' and of course it is under the law which governs nurses and midwives, the Health Practitioner Regulation National Law 2009. The first cohort of registered nurses is expected to complete their education, receive endorsement and start prescribing medicines from July this year, 2026, and this bill aligns with that new registration standard. The Nurses and Midwifery Board registration standard, of course, also has a standard for endorsement for scheduled medications. The designated registered nurse prescriber came into effect in September 2025. The standard describes the necessary qualifications that a registered nurse must demonstrate when applying to the Nurses and Midwifery Board to attain and retain the endorsement for scheduled medications.

I note the Nationals' view earlier today regarding opposition to this bill due to the system being untested. Sadly, this is an uninformed view of the real world. It dismisses the extensive consultation that was done with stakeholders, including the Royal Australian College of General Practitioners, the Australian Medical Association, palliative care nurses of the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, and the Australian Primary Health Care Nurses Association. This bill is backed by extensive consultation and real-world experience. It meets the desperate need for better access to care, particularly in primary care and aged-care services.

This bill makes two critical amendments to the legislation. One is the National Health Act 1953. We are amending this to allow registered nurses endorsed against a strict registration standard to be authorised prescribers. This means that they can prescribe certain medications under the Pharmaceutical Benefits Scheme, ensuring that patients get their Commonwealth subsidy regardless of whether a doctor or an endorsed nurse writes the script. The second piece of legislation is the Health Insurance Act 1973. We are ensuring integrity and safety by including nurses in the Professional Services Review. It's a scheme that ensures that prescribing habits are reviewed and held to the highest professional standards, just as we do with medical doctors. This bill isn't just a technical amendment; it is a structural renovation of Medicare and it is fit for the 21st century.

But I note that this reform doesn't exist in a vacuum. For too long, Australia has had a siloed approach to healthcare. We have highly trained professional nurses, pharmacists and allied healthcare workers who are restricted by legacy regulations that no longer match their modern education. My own experience, of course, before I entered this place was as a remote-area nurse. My office wasn't a suite in parliament; it was the corridors of hospitals, it was bush clinics and, in fact, at times it was in the bush itself. I stand here not just as the member for Bullwinkel but as a registered nurse and as the 10th nurse to be elected to parliament. I'm proud to be part of this government that's delivering this reform. I've seen how multidisciplinary teams work best when the hierarchy is replaced by a circle of care. Anyone who has worn the nursing uniform knows that nursing is the backbone of the Australian healthcare system. We are the ones who stay and provide ongoing support to patients long after the medical consultation has finished. We are the ones who monitor the vitals in the quiet hours of the night and notice the subtle changes. And of course we are the ones in primary health care and rural and remote areas where we are, at times, the only clinician for hundreds of kilometres. We are the ones who see with heartbreaking clarity the gaps in the patient's journey, the moments where a delay in the signature or a script leads to an increase in pain or a decline of their health. This bill is about closing those gaps.

I want to share a little bit of my history to illustrate why this bill is so vital. Earlier in my career as a remote area nurse, I didn't have the luxury of 24-hour imaging departments or a local pharmacy just at the end of the road. Many of those communities, of course, exist, and some are regional and remote communities even in my seat of Bullwinkel. To serve those communities, I underwent intensive and additional training to expand my scope of practice. I wasn't just monitoring vitals and taking clinical assessments; I was actually taking X-rays. I was in the darkroom, developing those X-rays. I was taking bloods, making referrals and, at times, prescribing essential medications that were needed to stabilise patients before they could see a doctor or be evacuated. I know what it's like to carry the weight of that responsibility and work within your scope of practice but still give the care that only you can give in a situation like that. I also know the incredible efficiency and safety that comes when a highly trained nurse is empowered to use the full extent of their skills. When I was in these remote area clinics, I wasn't acting as a doctor; I was acting as a highly specialised nurse, delivering the right care at the right time because someone needed it.

This bill takes the spirit of flexibility and clinical excellence and brings it into the 21st century for all Australians. It recognises that the skills that I used in the desert and the bush are skills that should be harnessed across our entire health system to make it more resilient. By allowing designated registered nurse prescribers to operate within their scope after having additional education, we are removing the middleman delay. We are saying to consumers of the health system, 'Your health is too important to wait for a clerical hurdle, especially when we have trained experienced nurses who are available to help and present.'

I want to be clear for those that might have questions about this transition. This reform is about professional evolution, not substitution. This is about recognising the high level of clinical expertise that already exists within our nursing ranks and provides a formal, regulated pathway to use it. The first cohort of these prescribers is expected to finish their specialised education and receive their endorsements by July 2026. These are professional, well-credentialed nurses who have completed rigorous postgraduate-level nursing training.

As a nurse, I know that my nursing registration is my most valuable asset, I belong to one of the most trusted professions in the country, and I adhere to strict clinical guidelines. The endorsement process ensures that only those with the right clinical expertise and education will be writing these scripts. It is a controlled, safe and logical extension of the work that nurses already do every single day to support their patients and their medical colleagues.

We are delivering on a commitment. This is a fundamental election promise made by the Albanese government to prioritise the scope-of-practice reforms for nurses and midwives to deliver real, tangible benefits to Australian patients. This bill is a win for families in Bullwinkel and across Australia, particularly those in regional and rural Australia, who deserve every available option to access their health care efficiently. It is about adding another layer of support to our primary healthcare network and ensuring that, wherever you are—be it in a suburban clinic or remote area—the system is working for you and that you do not have to wait for a doctor to visit, on occasions which are sensible and appropriate. It is a win for the nurse who knows that their patient's needs intimately and can now provide a more seamless transition of care, and it is a win for a more sustainable multidisciplinary health system where every professional—doctor, nurse and allied health worker—is empowered to work at the top of their training.

The Albanese government is committed to supporting our health workforce. As I said at the start, it's not just strengthening Medicare; it is doing the hard legislative work to make it accessible for all Australians. When I look back on my time in my career, this legislation would have been very helpful. Today, I'm proud to be part of the government that's delivering this reform. I commend this bill to the House.

Tim Wilson (Goldstein, Liberal Party, Shadow Minister for Small Business) Share this | Link to this | Hansard source

I thank the member for Wannon for his enthusiasm at the opportunity to listen to a speech characteristically to legislation before the House from the member for Goldstein—of course, certainly better than the predecessor member for Goldstein, I'm sure, on the subject matter of which he is humbly agreeing with as well.

The point of this legislation, of course, as was mentioned by the previous speaker, is straightforward, but we need to acknowledge it sits in a much broader context about the health care of this nation. We all have a natural interest in having a sustainable health system for our country. Doing so is one that supports the workers to be able to go on and deliver the primary care they need in community, and that's of critical importance. One of the things that COVID demonstrated or revealed to all of us is the health inequity that exists across our country around access to services between not just rural and regional areas but also affluent and less affluent parts of capital cities. In a moment of crisis, when people need care, it's explicitly revealed to the whole of the nation. The question is how you seek to address that and make sure that the system is sustainable and gives people the support that they need.

What we've heard from this government to date around health care has been principally, as they hold up their Medicare cards, that everybody can go to the doctor for allegedly free. I now see the television propaganda that has been pushed out by this government to try and reinforce their political messaging. The problem is anybody who has actually gone and visited a doctor. And let's start with the ACT, which is not my constituency, and I can assure you it probably never will be. But, as people who live in the ACT said to me only the other day, there are no bulk-billed doctors in the ACT, the heart of this nation politically. Surely, if the government is going to achieve its objective anywhere, it is here. Yet there are no bulk-billed doctors in this capital city for people. So, if you're low income, you're not getting support. You're a pensioner who doesn't have the financial means and resources to be able to pay. So, despite the bluster and the rhetoric and the holding up of the Medicare card and waving it around and all of the other rubbish that the Prime Minister goes on about, it is not being lived by Australians. A Medicare card comes with a credit card if you want to be able to access a doctor in large parts of this country. No matter what they say and no matter what they do, they are not delivering on the words they promise.

You think about the distrust that breeds within the community, where they see the so-called political leader of this nation waving their card around and saying, 'We're the answer and we're giving that pathway,' and then they go and live a very different reality of a co-payment. Let's be honest about health care. Let's be honest about how people are living and what happens with health care. You can ration health care by one of two ways: price or lists. And the answer of this current government is to do both of those things, which is a completely irrational conclusion. You have to wait longer for higher and more expensive health care, principally so that they can feed the interests of the select few they seek to represent through the trade union movement rather than what we should actually be doing in health care, which—call me radical!—is focusing on patient outcomes. That's my radical proposition. I think we should run a healthcare system focused on patient outcomes that actually empowers Australians to be able to get the health and support and community through primary care to minimise long-term dependency on tertiary care and, more importantly, to make sure that people can live their best, full lives as healthy, engaged participants in the community and the workforce so that they can be happy, not a system designed to keep people ill to feed the benefits of the unions and the people that they are paid to represent and to maintain the political control by the Australian Labor Party.

So that's the situation we currently face in health care, but that doesn't mean that occasionally we get pieces of legislation that come along that at least can do some good to try and change that, because even the Labor Party know the gig is up and they're not going to be able to sustain the health system that they rhetorically promote through their words and their propaganda on television because Australians know the gig is up because they're living the opposite reality. So, when you empower registered nurses to be able to prescribe things off the PBS in certain circumstances and when they're authorised to do so, you help empower nurses, reduce costs and hopefully get better care pathways through to achieve what I believe the central objective of the health system should be, which is to improve patient outcomes. That is a worthwhile objective, and, frankly, I'm very open to many measures that seek to achieve this in many realms, particularly in the healthcare system, to make it more sustainable, to reduce costs and to improve best outcomes for Australians and best healthcare outcomes for Australians.

Having served on the Nursing and Midwifery Board of Ahpra from 2010 until about 2013, I've seen what happens within the sector. You see the enormous pride that nurses rightly take in their profession. But, as is often the case with disciplinary and registration boards, you also, tragically, see the consequences of when trust is abused. We see that in this place with certain committees as well, where trust is abused. But when there are improper and rigid guidelines around access to certain healthcare services and certain medicines there are a select few who, unfortunately, abuse that trust for their own gain and their own benefit. Getting the balance in law is right because it's such an important part of it.

What we have here is legislation that addresses a pathway for registered nurses who are qualified, have capacity and have the regulatory framework to be able to do their jobs better, to allow better outcomes for patient care. On that basis, I'm very supportive of the principle of the legislation as passing it will improve patient outcomes, will improve healthcare services and will actually free up capital and time for nurses, doctors and specialists to be able to support patients where it's needed. That's going to continue to be a big challenge for our country into the future.

We know what happens if we don't do that. We're going to have higher costs and unsustainability in the system that will come through via lower quality care in communities, particularly in lower socioeconomic communities and rural and regional areas. We know that it will make it harder to be able to build a robust and resilient health system that this nation needs.

You only need to look at what is happening in the British and Canadian systems. Because of their rigidity with a system geared towards the interests of union members, not patients, the consequences that then flow from that mean people increasingly have to wait, they are denied care and, because they can't buy things on the basis of price, they are forced to ration on the basis of lists. The lists are getting longer and longer and longer and longer and longer. This feeds distrust and resentment within the Australian community, because those who need services are not able to access them, and we're not getting the health outcomes that Australians desperately need.

In the context of putting forward a practical, modest measure, I implore the government that finally they might start to work towards a healthcare system that works for the Australian people based on honesty, based on patient outcomes and based on improving the health and wellbeing of this nation.

Tom French (Moore, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. This bill represents a careful and deliberate reform to Australia's health system. It strengthens Medicare, improves access to affordable medicines and ensures that our health workforce is better supported to meet rising demand by enabling professionals to work to their full and appropriate scope of practice. It is a reform grounded in evidence, consultation and an understanding of how health care is delivered on the ground in communities across Australia.

At its core, this legislation amends the National Health Act 1953 and the Insurance Act 1973 to allow appropriately qualified and endorsed registered nurses to prescribe certain pharmaceutical benefits under the Pharmaceutical Benefits Scheme. Importantly, it does so within a clearly defined regulatory framework that includes professional oversight, prescribing agreements and established accountability mechanisms. This legislative change reflects a broader shift in how health care is delivered in Australia.

Contemporary care increasingly relies on multidisciplinary teams, continuity across settings and the effective coordination of skills, and yet our legislative and funding frameworks have not always kept pace with these changes. In the many parts of the health system, professionals are trained to undertake responsibilities that existing settings prevent them from exercising fully. This creates inefficiency, duplication and frustration both for patients and for providers. Addressing these barriers is essential if Medicare is to remain responsive and sustainable.

This bill takes a targeted approach to reform. Rather than restructuring the system wholesale, it removes a specific constraint that has been well identified through policy review and professional consultation. It enables appropriately qualified registered nurses to contribute more fully within defined clinical and governance arrangements. By doing so, it supports a health system that is better aligned with how health care is delivered in practice, particularly in primary and community settings where demand continues to grow.

Australia's health system is under sustained and increasing strain. In my electorate, the Joondalup Health Campus serves a large and growing population across Perth's northern corridor and highlights the importance of strong primary and community care in supporting timely treatment and safe transitions for patients. Nurses at the Joondalup Health Campus already play a critical role in assessment, care coordination, chronic disease management and discharge planning. What this bill recognises is that in appropriate circumstances and within defined governance arrangements those nurses should be able to complete an episode of care rather than fragment it. Enabling appropriately endorsed registered nurses to prescribe under the Pharmaceutical Benefits Scheme supports safer transitions from hospital to community care, reduces unnecessary delays in treatment and helps prevent avoidable readmissions. For a health campus operating at scale, and for a community that relies on it every day, these efficiencies matter. They improve patient flow, reduce pressure on emergency departments and support better continuity of care once a patient leaves hospital.

Demand for care continues to grow as our population ages and as more Australians live with chronic and complex conditions. These pressures are compounded by workforce shortages, particularly in primary care and general practice. Too often, these challenges manifest as long wait times, fragmented care pathways and avoidable escalation of care that could have been better managed earlier in community settings. Enabling appropriately endorsed nurses to prescribe under the PBS allows care to be delivered more seamlessly within existing service models. It reduces the need for multiple appointments and supports continuity, particularly for patients with ongoing care needs. For constituents, this can translate into more timely access to treatment, fewer delays and a better experience of the health system. For providers, it supports more efficient use of clinical time and skills.

This reform recognises how care is delivered on the ground in growing outer metropolitan communities and ensures Medicare settings better reflect those realities. Enabling registered nurses to prescribe under the PBS within defined parameters directly supports that goal. It allows care to be delivered more efficiently and reduces unnecessary duplication while preserving clinical governance and patient safety. For patients, this can mean faster access to treatment and fewer barriers to care. This bill responds to those realities by making better use of the skilled health workforce already embedded in our communities.

Registered nurses comprise approximately half of Australia's health workforce and play a central role across the health system. Yet, despite their expertise, regulatory and funding arrangements have often limited their ability to operate at the top of their scope, particularly in the primary and community based care areas. The reforms in this bill allow endorsed registered nurses who meet rigorous education, experience and accreditation requirements to prescribe specified medicines under the PBS. This enables patients to receive timely and affordable treatment from the health professional who is already providing their care, without unnecessary duplication, delay or additional appointments.

It is important to be clear that this reform is not about replacing doctors or diminishing the role of general practitioners. Rather, it is about strengthening multidisciplinary, team based care. Modern health systems function best when each professional is supported to contribute their skills within a coordinated and collaborative framework.

The policy foundations for this reform are well established. The Strengthening Medicare Taskforce identified scope-of-practice reform as essential to improving access, affordability and sustainability in primary care. That work was reinforced by the scope-of-practice review, which found that unnecessary regulatory barriers were preventing health professionals from contributing fully to patient care and system efficiency. Alongside this work, the Nursing and Midwifery Board of Australia, working with the Australian Chief Nursing and Midwifery Officer, undertook extensive research and consultation on nurse prescribing. This process commenced several years ago and involved engagement with governments, nursing and medical organisations, medical organisations, clinicians and consumers. It culminated in the endorsement of a new registration standard for designated registered nurse prescribers by all health ministers, which came into effect in 2025. This bill provides the necessary Commonwealth legislative framework to support that standard by enabling access to the Pharmaceutical Benefits Scheme.

It is worth setting out how this legislation operates in practice, because its safeguards are central to its integrity. The safeguards contained in this bill are comprehensive and deliberate. Eligibility, approval and prescribing arrangements operate together to ensure that nurse prescribing under the PBS occurs within a framework that prioritises safety, accountability and professional standards. Approval as an authorised nurse prescriber is not automatic. Applications must be assessed by the secretary, and approvals may be subject to conditions. Chief among these requirements are prescribing agreements with other authorised PBS prescribers. These arrangements embed nurse prescribing within collaborative, team based models of care. The inclusion of authorised nurse prescribers within the Professional Services Review scheme further strengthens accountability. It ensures consistency and oversight across the PBS and provides mechanisms for peer review and sanction where appropriate. These measures collectively demonstrate that the reform balances improved access with strong governance and public confidence.

The bill also makes clear that authorised nurse prescribers may only prescribe pharmaceutical benefits determined by the minister for the purposes of the PBS. In making those determinations, the minister must have regard to the advice of the Pharmaceutical Benefits Advisory Committee. This preserves the independence, rigour and evidence-based nature of PBS decision-making. Further, authorised nurse prescribers will be subject to the Professional Services Review scheme under the Health Insurance Act. This ensures that their PBS prescribing is subject to the same peer review and accountability mechanisms that apply to other PBS prescribers, maintaining the integrity of the system. This bill includes provisions allowing the secretary to suspend or revoke approvals where conditions are breached, along with clear notification and review rights. These measures ensure that participation in nurse prescribing is contingent on ongoing compliance with professional and legislative requirements.

From the perspective of the electorate I represent, the benefits of this reform are practical and tangible. Across Moore, nurses already play a central role in managing chronic disease, supporting older Australians, delivering preventive care and coordinating services for people with complex needs. Allowing appropriately endorsed nurses to prescribe under the PBS enables more complete and efficient episodes of care. For older residents managing multiple medications, this can mean fewer appointments and better continuity. For families balancing work and care responsibilities, it can mean less time navigating fragmented services. For people living with chronic illness, it can mean earlier intervention and reduced risk of avoidable deterioration.

This reform is also significant for equity of access. Workforce shortages are not evenly distributed. Regional and remote communities and some outer metropolitan areas have greater difficulty attracting and retaining health professionals compared with metropolitan centres. By expanding the capacity of nurses to deliver care within their scope, this bill helps ensure that access to affordable medicines is not constrained by geography or workforce bottlenecks. It also supports the sustainability of general practice. By enabling nurses to manage appropriate prescribing within collaborative arrangements, general practitioners are better able to focus on patients with complex diagnostic needs, multimorbidity and care coordination requirements. This strengthens rather than undermines the role of general practice.

International experience supports this approach. Nurse prescribing models operate safely and effectively in countries such as the United Kingdom, Norway, Ireland and the Netherlands. Evidence from those systems demonstrates that non-medical prescribing, when governed properly, improves access to care, supports workforce retention and maintains high standards of patient safety.

The bill makes clear that prescribing by authorised nurse prescribers will commence only after the relevant delegated legislation is in place. The use of legislative instruments to determine the prescribing scope ensures flexibility while maintaining parliamentary scrutiny. It allows adjustments to be made in response to evidence and experience without undermining the integrity of the framework. It recognises that modernising health regulation requires both ambition and caution, particularly where patient safety and public confidence are concerned. By embedding oversight, review and accountability mechanisms, the bill ensures that implementation proceeds in a way that is transparent and adaptable.

This reform is focused on improving how care is delivered within the existing health system rather than changing infrastructure or hospital planning settings. The financial impact of this bill indicates there is no expected additional cost to the PBS. That reflects the fact that this reform changes who can prescribe, not who is eligible to receive, the subsidised medicines. It improves access and efficiency without expanding entitlement.

Taken together, the measures in this bill modernise Australia's health legislation to reflect contemporary practice and patient needs. They strengthen Medicare's capacity to respond to demand and support a workforce that is better equipped to deliver timely, high-quality care. For the people I represent in Moore, this matters. It means a health system that works more effectively in practice, recognises the professionalism of nurses and delivers care when and where it is needed. For those reasons, I support the bill and commend it to the House.

Allegra Spender (Wentworth, Independent) Share this | Link to this | Hansard source

I rise to support the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. This bill amends the National Health Act 1953 and the Health Insurance Act 1973 to allow authorised nurse prescribers who meet strict criteria to prescribe certain pharmaceutical benefits under the Pharmaceutical Benefits Scheme. The types of medicines that can be prescribed will be clearly specified by the minister, and there will be appropriate safeguards in place. This includes oversight by the Professional Services Review, which will now extend to PBS prescribing by authorised nurse practitioners. These changes are not radical; they are sensible, evidence based reforms that flow directly from the recommendations of the Strengthening Medicare Taskforce and the Scope of Practice Review, both commissioned by the government following the 2022 election.

At its core, this bill recognises something that many Australians already know to be true: our nurses are highly skilled professionals and are more than capable of working to the full extent of their training and expertise, and we want them to. Empowering healthcare practitioners, particularly nurses, is essential for our healthcare system to remain resilient in the face of an ageing population, rising rates of chronic illness, a growing mental health crisis and increasing demand in regional and rural communities. These pressures are not going away; if anything, they are intensifying, and we cannot meet these challenges by relying on outdated modes of care. We must be innovative in the ways we deliver health care, and we must make better use of the resources and talent we already have.

Even if our healthcare system didn't have these constraints, I would still support this bill because it allows nurses to work to the full extent of their capacity, and does that in a safe way for patients but also in a way that gives professional satisfaction for nurses. These highly trained individuals, these important members of our community, should have the satisfaction of being able to work to the full extent of their training and their capability. That reason alone is enough to support the bill, but at the same time this will provide important support for our healthcare system. This will mean that patients and members of our community can more easily access the health care they need when they need it, and that is another incredibly important reason to support this bill. We know there is international evidence that these models of care can work safely and effectively around the world. I've seen some of this personally, in my own experience working in the UK healthcare system.

I believe this bill strikes the right balance. It expands the scope of practice while maintaining strong safeguards. That's what I think Australians want from us. They want to feel safe, they want to feel in good hands when they go to a GP service or to any of our hospital or healthcare services, but they also want to make sure that our nurses, who we respect and whose care we value, get to work to the full extent of their practice.

Let's be honest. There are a couple of other things. For those people who might be nervous about this bill, it expands the scope of practice, but it does have strong safeguards. Only appropriately qualified nurse prescribers will be authorised, and there will continue to be oversight to ensure prescribing is safe, appropriate and accountable. This reform will not solve every challenge facing our healthcare system, but it is a practical and necessary step in the right direction. It reflects the trust that we have in our healthcare workforce, supports better patient outcomes and helps build a more flexible and sustainable healthcare system for the future. For these reasons, I support the bill.

Louise Miller-Frost (Boothby, Australian Labor Party) Share this | Link to this | Hansard source

For many years before I came to this place I worked in the health sector in South Australia. I ran a large number of services across northern and central Adelaide and some statewide services. Another of my roles included recruitment of overseas doctors to rural and remote South Australia, and this was partly because we don't have enough doctors in Australia and partly because many of them don't want to work in rural and remote areas. Many of these basic services—general practitioners who often also cover at the local hospital—were reliant on being able to recruit doctors, nurses, pharmacists and allied health workers from overseas who were required to spend at least a few years in rural and remote areas. Health services are reliant on qualified staff to run, and, unfortunately, as a country we have not been training up enough of them for decades. We also have an ageing population, and often with ageing comes an increased reliance on the health system—bodies wear out, chronic diseases develop, trips and falls become more catastrophic. So we need more of these health professionals, and we needed them yesterday.

There are ethical issues about recruiting precious health worker resources from other countries; they need them as well. The alternative is that we train them up here in Australia, and we absolutely need to be doing that. But it takes time, and we needed this extra workforce yesterday. Our health system is under pressure today from increased demand and from workforce shortages. A doctor takes six years of university study, then an internship. A GP takes a further five years on top of that. A nurse takes an undergraduate degree of three years, and a nurse practitioner takes at least three years experience and then a master's degree on top of that. A pharmacist takes a minimum of four years of study, plus one year of an intern training program. We are not going to be solving our health workforce shortage here in the next year or two through training up additional workers here, although we absolutely need to be doing that.

When I spoke to the now minister for health and ageing a couple of years ago, I was really pleased to hear about the work that was being done on scope of practice across a number of different professions in the health workforce. Today I'm pleased to be able to support the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025. It's a practical, forward-looking reform that strengthens Medicare, supports our health workforce and improves timely access to affordable medicines for Australians no matter where they live.

At its core, this bill amends the National Health Act 1953 and the Health Insurance Act 1973 to allow appropriately qualified registered nurses to prescribe certain medicines under the PBS. It's not a radical step. It is a sensible evolution of modern health care, one grounded in evidence, informed by expert review and driven by the needs of patients. Importantly, it makes the best possible use of our existing health workforce, which is good for patients, is good for the health workers themselves and is good for our overall health system.

The purpose of healthcare reform should always be clear: better outcomes for patients. Today too many Australians struggle to access timely care. In rural and regional communities patients often travel long distances simply to obtain a prescription. In our outer suburbs families can wait days, sometimes weeks, for appointments. This bill addresses those barriers directly by enabling authorised nurse prescribers to prescribe medicines on the PBS. Patients receiving treatment from these clinicians will be able to access subsidised medicines without unnecessary delay. This is about equity, about ensuring that where you live does not determine the quality or speed of your health care and about recognising a simple truth: when patients receive treatment earlier, outcomes improve and pressure on the system declines.

Australia's nurses are among the most highly trained and respected professionals in our health system, yet, for too long, rigid regulatory settings have prevented many of them from working their full scope of practice. This bill changes that. It establishes a formal process through which eligible registered nurses may be approved as authorised prescribers with mechanisms for suspension or revocation if standards are not met. It also ensures that these prescribers are subject to oversight by the Professional Services Review, the same safeguard applied to other PBS prescribers. And, to be clear, this reform expands access without compromising safety. Prescribing will remain contingent on appropriate education, competency and registration requirements already fundamental to safe clinical practice in Australia. In other words, this is reform with guardrails.

But this legislation does not emerge in isolation. It implements recommendations from the Strengthening Medicare Taskforce and the Scope of Practice Review, reforms designed to empower health professionals and modernise primary care. Those reviews recognise what many clinicians already know: Australia cannot meet growing healthcare demand without using the full capability of our workforce. Designated nurse prescribing will help ease workforce pressures, build long-term system capacity and support sustainability across primary care. By enabling suitably qualified nurses to expand their scope of practice, it will also support workforce retention issues. At a time when emergency departments are crowded and GP shortages are felt across the country, we cannot afford to leave skilled professionals underutilised. This is smart reform, the kind that improves productivity while enhancing patient care.

If there is one place where this reform will make an immediate difference, it's rural and remote Australia. The government has been clear: empowering nurses to practice at full scope will provide more equitable access to treatment for people living outside our major cities. As well as running health services across SA, including some rural and remote services, I also lived in a very small country town for a number of years, providing services into general practices scattered across remote SA. Access to timely health care can be a challenge in remote areas and can require considerable planning and travel. Consider the farmer managing a chronic condition hundreds of kilometres from a specialist or an elderly resident in a small town whose local clinic struggles to recruit doctors or the young family who cannot afford repeated travel just to renew a prescription. For these Australians this bill is not theoretical; it's transformational. It means fewer delays, fewer avoidable hospital visits and greater continuity of care within their communities.

The minister's second reading remarks captured the reforms succinctly. Empowering nurses to provide safe, high-quality care directly in the community reduces the need for GP visits and long waits in overcrowded emergency departments. This is precisely the kind of structural reform our health system needs. Too often patients end up in hospital because primary care was inaccessible. Too often GPs spend valuable consultation time on straightforward prescribing tasks when their expertise could be better utilised elsewhere. Allowing trained nurses to manage appropriate prescribing frees doctors to focus on complex care, a win for efficiency and a win for the patients.

This reform also aligns with Australia's longstanding commitment to affordable medicines. The government has stated that the change promotes equitable, affordable and timely access to high-quality medicines and services consistent with the National Medicines Policy. And let's remember what the PBS represents: for generations, it has been a cornerstone of Australian health care, ensuring that life-saving medicines are accessible not only to the wealthy but to every Australian citizen. By expanding the pool of authorised prescribers, we strengthen that system rather than strain it. Access delayed is access denied, and this bill ensures access delivered sooner.

As with any reform, stakeholders have raised questions, particularly about which medicines nurse prescribers may ultimately prescribe. These matters, however, will be determined by the minister through disallowable legislative instruments, allowing appropriate scrutiny and flexibility as clinical practice evolves. This is good legislative design. It ensures parliament establishes the framework while allowing expert guidance to shape operational detail. So let's not let hypothetical fears overshadow the very real benefits this reform will deliver.

Australia has successfully expanded prescribing roles before to nurse practitioners, dentists, optometrists and midwives, always with patient safety at the forefront. And it isn't unknown overseas either. In the UK, most community health visitors have the V100 or community practitioner nurse prescriber qualification. In New Zealand, nurse practitioners have been authorised to prescribe within scope of competence since 2001. In South Africa and Canada and even in all 50 states of the US, nurse practitioners can prescribe. This is not a radical change. It is a well-thought-through logical change with strong guardrails, and it continues to put patient safety and patient wellbeing at the centre of health care.

The National Health Act 1953 has long underpinned the provision of pharmaceutical and medical services in Australia, but a health system built for the 1950s cannot remain frozen in time. Our population is ageing. Chronic disease is rising. Demand for care is growing faster than workforce supply. If we fail to modernise, we risk bottlenecks that hurt patients and exhaust clinicians. This bill is exactly the kind of targeted legislative update required to meet 21st century challenges, not sweeping upheaval but thoughtful adaptation.

Sustainability is not only about funding; it's about structure. A resilient health system distributes responsibility across a skilled, multidisciplinary workforce. It encourages collaboration rather than hierarchy. It removes unnecessary barriers that prevent professionals from delivering care. By building long-term capacity, this reform will strengthen the system for decades to come. Future governments, regardless of political persuasion, will benefit from the foundations laid today, because good health policy should never be partisan. It should be pragmatic.

This is part of a broader vision. The Australian healthcare system, despite its challenges, is world class. If you are sick or injured, you wouldn't want to be anywhere else in the world. But it is a system under pressure, where demand is rising, and so we need to continue to ensure it works to its maximum ability with all the resources, including workforce, that we can provide. This change enacts the vision of a health system where nurses practice to their full capability, patients receive timely treatment, rural communities enjoy genuine healthcare equity and hospitals are reserved for those who truly need them. This is not an abstract aspiration. It is exactly what this legislation advances.

The Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025 is measured, responsible and necessary reform. It empowers trusted professionals. It improves access to medicines. It supports rural Australians. It reduces system pressure. It strengthens Medicare. And, most importantly, it places patients, not bureaucracy, at the centre of care. Parliament is often at its best when it embraces practical reforms that make everyday life easier for Australians, and this is one of those moments. Let us back our nurses and modernise our health system to ensure that every Australian can access the care they need, when they need it, where they need it, no matter where they call home. I commend the bill to the House.

Monique Ryan (Kooyong, Independent) Share this | Link to 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.

Madonna Jarrett (Brisbane, Australian Labor Party) Share this | Link to this | Hansard source

I rise in support of the Health Legislation Amendment Bill 2025, which is about prescribing medicines listed on the Pharmaceutical Benefits Scheme. Access to universal free health care is one of Labor's greatest legacies to Australia, and this bill is just another part of that. You know, I'm one of eight kids. I have no idea how my parents would have possibly managed had we not had access to free health care via Medicare and subsidised medicines through the PBS. My pensioner grandparents, who lived next door, absolutely relied heavily on Medicare and the PBS in their later years.

This bill builds on Labor's commitment to make health care more accessible and more affordable for all Australians. This bill increases access to and availability of medicines for all Australians. Importantly, it will allow registered nurses to prescribe certain medicines that can be supplied under the Pharmaceutical Benefits Scheme and attract a Commonwealth subsidy. Again—

Steve Georganas (Adelaide, Australian Labor Party) Share this | Link to this | Hansard source

The debate is interrupted in accordance with standing order 43. The debate may be resumed at a later hour. The member for Brisbane will have leave to continue speaking when the debate is resumed.