Rosanne Flemming NP
30 Aug 2009

Dear Mr Dutton

I am a constituent of your electorate of Dickson and I am also an Endorsed Nurse Practitioner (Aged Care) in Queensland. I have been advised by my professional body, The Australian College of Nurse Practitioners, that you are not willing to support the legislation to allow Nurse Practitioners access to MBS and PBS in their practice. As the opposition spokesperson on health, I feel it is imperative you have an understanding of the ‘coal-face' issues surrounding the proposed access to Medicare and Pharmaceutical Benefits for Nurse Practitioners. You may be too young to have experienced first-hand the gross inequality of access to health services provided to the aged,
especially those living in residential aged care facilities, but I can assure you it is happening on an appalling scale.

I have been working as a senior registered nurse in residential aged care for more than 20 years and have consistently found a gross lack of equity in the provision and access to health care services for
these frail people. They are completely dependent on health professionals to bring services to them and cannot choose alternate action, without assistance, if they are dissatisfied. This situation
has not improved, in fact it has become worse, during my period of time working in residential aged care. This was one of the main reasons I completed the Masters Program to prepare me to work in this advanced practice role of NP.

I have witnessed a consistent lack of timely assessment and intervention from GPs when residents suffer a change in health status. I have also witnessed very poor, or no, management of chronic
illnesses by GPs which leads to functional decline and discomfort for sufferers. Many GPs respond to requests from Registered Nurses for a prompt visit from a GP with "I'm too busy - send him/her to
hospital". GPs generally will only visit residents in the facility during their regular scheduled time which may be weekly, fortnightly or monthly. There are many reasons for this lack of timely service,
including the fact that they generally do not like coming to nursing homes, are not skilled in geriatric or palliative care, and they can make a lot more money by staying in their surgery. I am friends with
many doctors who affirm the comment.

The lack of timely GP services results in prolonged discomfort and distress for the residents who may also suffer serious health consequences as a result. A visit to the emergency department for an
acute illness means they have to lie on a trolley for many hours before being assessed and treated. Many times residents are returned to the nursing home in the small hours of the morning, having spent
the whole time on a trolley - no food, no fluid, no toileting or pressure relieving care. More than 80% of residents in aged care facilities suffer from a degree of confusion when well, which is
exacerbated when they become unwell. They do not cope well with being transported in an ambulance, on their own, to a strange place with strange people.

The role of the Nurse Practitioner in Aged Care is to facilitate timely management of health issues within their scope of practice. This means being able to assess and treat minor illness such as a
urinary tract infection, request pathology tests to inform diagnosis, and prescribed treatment as required. NPs in aged care work closely with the GPs - this is a team effort, and they provide significant assistance to GPs caring for residents. NPs also provide timely care
for people who are dying, and can monitor and intervene with symptom management in a timely manner, thus ensuring optimal care and comfort at end of life.

However, these NP services are unavailable because there is no funding to assist with the cost of a NP consultation or any medication that might be prescribed. The current Commonwealth funding for aged care facilities does not allow for subsidisation of NP services. The vast majority of residents in aged care have fixed / limited income and are entitled to subsidised pharmaceutical and medical expenses. They cannot afford the cost of a private consultation and privately
prescribed medications, despite their desire to utilise the service. This is an appalling situation which must be rectified as soon as possible. The current Amendment under discussion will address this
disparity for aged persons living in residential care and the community.

It is widely recognised that Nurse Practitioner roles have developed in areas where patients are currently underserviced or disadvantaged, and that NP roles can contribute significantly to health outcomes for these populations. Nurse Practitioners can already safely prescribe
medicines but patients cannot access rebates on medicines and tests they prescribe necessitating out of pocket expenses for patients or double-consultations. For the NP role to achieve maximum health
outcomes there must be access to a medical and pharmaceutical benefit service so the most disadvantaged can utilise all the expertise and services now available if they choose.

The Health Legislation Amendment (Midwives and Nurse Practitioners) Bill currently being considered has the full support of peak nursing bodies throughout Australia. I respectfully request that you avail yourself of pertinent information to ensure you are adequately briefed on the role of the Nurse Practitioner in the current health system, and the significant, cost effective contribution these practitioners can make to health outcomes in Australia. I urge you to reconsider your position, and vote for the Amendment which will allow access to Medicare and PBS for NPs, thereby assisting disadvantaged people to gain equity of access to timely and appropriate health care services.

Yours faithfully

Rosanne Fleming NP, MNSc (NP), MN(Geront), BAPPSc,
GradCertEvidBasedComplMed, CertW'placeAssess&Training, FRCNA