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

I move:

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

37 Application of amendments

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

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

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

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

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

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

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

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

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

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

Mark Butler (Hindmarsh, Australian Labor Party, Deputy Leader of the House) Share this | Link to this | Hansard source

As I indicated, we won't be supporting this amendment. The effect of the amendment would really be to ensure that this particular group of registered nurses, who are now able to seek this endorsement through changes made by the board and will now be able to prescribe as state and territory parliaments change their legislation, which they have all committed to, will not be able to access the PBS. It would effectively make medicines more expensive for patients who had those medicines prescribed under changes that have already been decided on by the board and that are in the process of being made by state and territory parliaments. This legislation will simply ensure that those patients are able to pay PBS prices, not the market prices that the National Party would have them pay under their amendment.

I also indicate—and I think I said it in my summing up—that this has been the subject of almost a decade of consultation and modelling by the nurses' board. All the doctors' groups were involved in this as well as, obviously, a range of other groups. The member said that there was no funding available for this. As the member well knows—I know she's very familiar with primary care—the workforce incentive payment already supports the employment of registered nurses in primary care settings. This will simply ensure that they're able to do some more work subject, obviously, to the oversight of medical practitioners working in those practices. Importantly, this will also enable registered nurses, subject to the endorsement of the board, to play a prescribing role, in the appropriate way, in other settings such as: aged-care settings; hospital settings, including for discharge; mental health settings; and others. For those reasons, we will not be supporting the amendment.

Milton Dick (Speaker) Share this | Link to this | Hansard source

The question is that the amendment moved by the honourable member for Mallee be agreed to.

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

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

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

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

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

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

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

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

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

84AANA Additional requirements for authorised nurse prescribers

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

(2) The requirements may relate to:

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

(b) making contributions to the National Medicines Record.

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

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

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

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

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

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

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

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

Mark Butler (Hindmarsh, Australian Labor Party, Deputy Leader of the House) Share this | Link to this | Hansard source

I thank the member for Mackellar for those remarks and also her engagement on this bill and other bills—particularly in the health portfolio, given her background. She raises some issues that are being ventilated in the Senate committee inquiry in relation to this bill, which is still underway; the committee hasn't yet reported. I reiterate what I said in response to the member for Mallee's amendments—that this change, that's been endorsed by the board and will be the subject of enabling legislation at state and territory level, has been the subject of nine years of work, with patient safety right at the core of that work.

I'm glad to hear the member for Mackellar's comments around the national medicines record that I announced last week. 'Prescriber shopping', which was the term the member for Mackellar used, has become much more of a challenge in a telehealth environment. Some tragic cases, one in particular, led to the government making that announcement last week to ensure all prescribers—because that was a question of the number of doctors prescribing—have access to and actually use the records. As I said in response to the member for Mallee's amendments, we've made the announcement. There will now be a process of consultation to design the national medicines record, and we will obviously take account of any change to the prescribing population as we go forward.

The other comments, though, that the member for Mackellar makes about the submissions that the college and the AMA have made to the Senate committee, we will take into consideration if this bill passes the House and then moves to the other place after the committee has reported. I want to emphasise again that both doctors' groups were heavily involved in that consultation. Indeed, both of them have pointed to that consultation as being a very high standard compared to another consultation that is under way right now that they're not as happy about.

But I also want to say the prescribing rights of this population of registered nurses, who will have to have done additional training and receive the endorsement of the board, is proceeding. Whether or not this bill passes the parliament, that is proceeding. The board has made that decision. State and territory governments have made the decision that they will amend their legislation.

The bill before the House now determines whether or not a patient who has a prescription made by an eligible nurse is able to access the PBS, and the member for Mackellar well understands that. This really is an affordability question before the House and then after it the other place, so we will not be supporting the member for Mackellar's amendments in this place. Her comments obviously come from a very good place and from a very rich background as a medical practitioner. We will listen to the submissions that are made by the AMA, the college and other groups that are participating in the Senate committee inquiry. But, as presently advised, we'll be opposing the amendments.

Bill agreed to.