Collaborative Arrangements

COLLABORATIVE ARRANGEMENTS END ON 1st NOVEMBER 2024.
 

On 1st November 2024, after 18 months work by the Department of Health and Aged Care (DOHAC), supported by a long campaign from ACNP, the requirement for a Collaborative Arrangement will cease.

We expect a lot of attention and media, and both positive and negative responses to this news.  This page includes:

1. Facts about the Collaborative Arrangements

2. Myths about the Collaborative Arrangements

3. Frequently Asked Questions

4. A brief history

5. Resources - including links to media articles

We encourage you all to direct anyone with enquiries to this page.

 

30 October 2024 - Media release download this document

 

1. The Facts

What are the Collaborative Arrangements?
The Collaborative Arrangements under the Determination wholly and solely relate to a person being able to access MBS rebates for Nurse Practitioner services, and PBS subsidies for medicines prescribed by a Nurse Practitioner.

More people accessing health care with a Nurse Practitioner can now access Medicare rebates and PBS subsidies, and this is the only group affected by the removal of the Collaborative Arrangement requirement.

There is no change at all to Nurse Practitioner clinical practice.  

This change will reduce the administrative burden for some Nurse Practitioners.

This also means patients may not need to pay more out of pocket for visits to specialists, or for diagnostics, when referred by Nurse Practitioners privately or for medicines on private prescriptions. In addition, this means more of their health care will count towards their Safety Net entitlement.  The Safety Net protects our most vulnerable Australians. 

The use of the word 'Collaborative' has led to the repeated misinterpretation by other health professional groups that nurse practitioners must be supervised by doctors, when in fact, they were only ever required to be aligned to enable people to access their rebates and subsidies.  Nurse Practitioners are collaborative, they are regulated as autonomous practitioners, and are endorsed and work to the Nurse Practitioner Standards for Practice.  The alarm being raised in the medical media about Nurse Practitioners now being 'unsupervised' or 'unrestricted' is simply not based on fact.

The Australian Government has published a Fact Sheet on the removal of the requirement for a Collaborative Arrangement. 

2. The Myths

Most of the myths are centred around the removal of the requirement for a Collaborative Arrangement changing the way Nurse Practitioners practice.  As the Collaborative Arrangements are only related to MBS and PBS entitlements, there will be no change to clinical practice or collaboration.  

There is no change to Nurse Practitioner prescribing rights, this is governed by State and Territory Drugs and Poisons Legislation.

There is no change to the PBS - all the rules and restrictions are as per PBS (there are some changes expected from time to time, but this is unrelated to the removal of the Collaborative Arrangements)

There is no change to which diagnostic tests can be requested by a Nurse Practitioner under MBS (apart from the addition of Pelvic Ultrasound on 1 November 2024).  The full list of diagnostic tests can be found on MBS Online Note IN.0.6. Other diagnostic tests can be requested as private (patient pays) tests within the Nurse Practitioner's scope of practice.

There is no change to the item numbers on the MBS which can be found within note MN.14.12 on MBS Online, and (MN.14.1 - MN.14.16 are applicable, plus case conferencing, telehealth and some procedural items).

There is no change in relation to the clinical collaborative practice of Nurse Practitioners.

There is no change in relation to the autonomy of Nurse Practitioners

 

3. Frequently Asked Questions

Q. I engage a Nurse Practitioner in my business as a contractor or employee, do I need to do anything?

A. No, you do not need to change anything, however for some patients, they may have access to more rebates and subsidies.  There may be a lower administrative burden for your company, and/or the nurse practitioner.

 

Q. I work as a Nurse Practitioner in a public hospital, will anything change for me?

A. This is unlikely to affect you, as the requirement for a Collaborative Arrangement only applied to where patients were accessing MBS or PBS.  If you work in a public hospital where they do have some access (such as in the case of a 19(2) exemption), your patients' access may now be improved.

 

Q. I am a GP, and I work with a Nurse Practitioner, what do I need to know?

A. Nothing will change in the way you work together, this will only affect patients and their entitlements to MBS and PBS.  You can continue working together in th same way, and continue collaborating in relation to patient care.

 

Q. Will prescribing rights change for Nurse Practitioners?

A. No, they will not change, unless the relevant Drugs and Poisons legislation or regulations change in the State or Territory of practice.

 

Q. Will my patients have access to a wider range of medicines subsidised by PBS? 

A. No, not as a result of the removal of the requirement for a Collaborative Arrangement.  All medicines listed on the PBS for prescribing by Nurse Practitioners from the 1st November 2024 can be accessed without a Collaborative Arrangement in place, reducing the number of private prescriptions, and improving access to affordable medicines.  Other changes are being made to PBS listings, but this is not related to the Collaborative Arrangements.  Always check PBS and watch for updates from ACNP

 

Q. Will this mean more MBS items for services delivered by Nurse Practitioners?

A. No. However, it does mean existing items and rebates will apply for more patients.  Changes to the MBS are being made, but this is unrelated to the removal of the requirement for a Collaborative Arrangement.  Always check MBS Online and watch for updates from ACNP.

 

Q. Does this mean Nurse Practitioners no longer have to be supervised by a doctor?

A. There was never any requirement for supervision by a doctor, including where a Collaborative Arrangement was in place.  Collaborative relationships and mentorship can continue unchanged.  

If you have a contract or agreement that includes supervision of a Nurse Practitioner, that is entirely separate to the requirement to have a Collaborative Arrangement, and was never related or required.  ACNP has tried to work with organisations and associations to correct the misinformation about Collaborative Arrangements that has led to different types of unnecessary supervisory agreements arrangements. However, this misinformation continues.  

 

4. A brief history: 

In 2010, the ACNP and its members were consulted widely, as were consumers and other ‘stakeholders', in relation to changes to the Health Insurance Act to allow patients of NPs to access MBS rebates and PBS subsidies.  

The Determination relating to the Collaborative Arrangement was brought in at the last minute after the amendments to the Health Insurance Act were already made, and this meant that Nurse Practitioners had to have a Collaborative Arrangement in place with a Medical Practitioner to enable people to access their financial entitlements.  

In 2019, the final report of the Nurse Practitioner Reference Group as part of the MBS review Taskforce included a clear and evidence-based recommendation for removal of the requirement for a Collaborative Arrangement that was completely ignored by the Taskforce (all 14 evidence-based recommendations were ignored, despite a KPMG cost-benefit analysis that also supported the recommendations).  It was acknowledged at this time that the requirement for a Collaborative Arrangement had been widely misinterpreted by some groups, and that this was having a negative effect on the workforce and on access to health care.

In May 2023, the Nurse Practitioner Workforce Plan was launched, along with a commitment to remove the Collaborative Arrangements requirement for both Nurse Practitioners and Midwives, with a target of 18 months for completion.  This was considered a high priority, as the financial impacts on people accessing healthcare could not be ignored any longer, nor could the slow Nurse Practitioner workforce growth due to the numerous barriers to practice.  The removal of this requirement was extremely complex, and it is a significant achievement that the work was completed on target in 18 months.  This work is detailed on the DOHAC website.

The Nurse Practitioner Workforce Plan is an extremely important pathway forward to build and support access to high quality and safe care from Nurse Practitioners, and grow and develop the workforce for current and future health care needs.

 

5. Resources:

Australian Government Department of Health and Aged Care Fact Sheet 30/10/2024

The Nurse Practitioner Workforce Plan

Australian Government DOHAC: Collaborative Arrangements Project 2023

Media: ANMJ 17/05/2024  Outdated need for collaborative arrangements finally removed for Nurse Practitioners

Media Release: ACNP 20/03/2024 Australian College of Nurse Practitioners Applauds Bill to Remove Collaborative Arrangements 

Media Release: The Hon. Ged Kearney 20/03/2024 Making it easier to get top quality care from a nurse practitioner and midwife

Media: Mirage News 20/03/2024 Streamlining Access to High-Quality Care from Midwives, NPs

Media: The New Daily 20/03/2024 Australia's health care system 'groaning at the seams'

Media: Medical Republic 28/09/2022  - Nurse Practitioners Hit Back on Collaboration

Media: Medical republic 21/09/2022 - Nurse Practitioner Rules must stay, says AMA

Media: The Lamp 07/04/2021 - Nurse Practitioners done over by medical cartel

 

If you have any questions, or for all media enquiries, please contact the ACNP National Office on 1300 433 660.