The final report of the Medicare Benefits Schedule Taskforce Review (MBSTR) is “a perverse, offensive and oppressive rejection of nurses”, say experts.

A review commissioned in 2015 to better align Medicare with “contemporary clinical evidence, practice and improved health outcomes for patients” has, stunningly, rejected every one of the 14 recommendations of its own Nurse Practitioner Reference Group (NPRG).

The MBSTR had 43 working parties exploring specialty areas, almost all headed by medical doctors, and five reference groups, including a Nurse Practitioners Reference Group (NPRG). The taskforce of 15 mostly medical doctors then deliberated on the recommendations.

The 14 evidence-based recommendations by the NPRG sought to broaden the range of nurse practitioner (NP) services subsidised through the Medicare Benefits Schedule (MBS), in order to encourage the growth of the nurse practitioner workforce.

The recommendations focused on four key areas:

• supporting comprehensive and coordinated care for people with long-term health conditions and Aboriginal and/or Torres Strait Islander peoples
• enabling NP care for all Australians
• addressing system inefficiencies caused by current MBS arrangements and
• improving patient access to telehealth services.

The taskforce instead proposed three recommendations that 
further restrict the practice of NPs who provide services subsidised by the MBS.

Two academics, Mary Chiarella – a former NSW chief nursing officer, and Jane Currie – associate professor in Nursing at Queensland University of Technology, slammed the report, describing it as “a decision not to invest in nursing and the health of Australian communities”.

“It is unfathomable why the MBSTR should reject all 14 recommendations of a reference group they chose and instructed, a set of recommendations that sought to expand the role of NPs and make their services more accessible,” they said.

Medical clinicians “a vested-interest group”

Chiarella and Currie point out that the NPRG was meticulous in its analysis of MBS data, as well as referencing evidence-based data from the literature, and clinical guidelines from peer-reviewed nursing and medical journals and other sources.

“Research evidence tells us that NPs provide quality care, that patients are highly satisfied with their care and that NPs have increased access to health services,” they wrote in the online journal Pearls and Irritations.

“Other studies have demonstrated that NPs prevent presentations to EDs and that their expertise is drawn on significantly by the multidisciplinary teams.”

NPs, they point out, “have been at the forefront of emergency relief work during the NSW bushfires and in front-line acute care, aged care services, quarantine camps and international aid work in the Western Pacific during COVID-19”.

Professor Jill White, a former dean of the Faculty of Nursing and Midwifery at the University of Sydney, was highly critical of the bias in the report from medical clinicians who “are far from independent voices but rather highly vested-interest groups”.

“Nurses have put up with medical doctors’ organisations presuming to speak on our behalf for too long. Too long have medical doctors been the only health professionals setting policy direction and shaping funding models and controlling access,” she said.

Nurse Practitioner Lesley Salem says she and her colleagues are devastated by the MBS Taskforce Review.

“In this modern world where evidence is important, it was inconceivable that none of the recommendations were accepted,” she says.

Lesley says the report will impact negatively on the delivery of care to underserved and marginalised communities.

“MBS items are devised for the public to be able to access care. (The Taskforce) is denying the Australian public a choice in the type of care they can access and who delivers that care.

“As for marginalised groups such as the Aboriginal and Torres Strait Islander people, the homeless and those in remote Australia, they continue to be severely disadvantaged by the rejection of our MBS item requests.

“Many nurse practitioners work with these vulnerable groups. NPs can’t do an MBS health check, which would normally, legally, lead to a care plan that allows for referral to allied health, psychology and other services. An NP’s referral to these services results in the client having to pay for them. Marginalised groups cannot afford to do this.”

NPs will not take this decision lying down, Lesley says.

“The medical model for closing the gap in healthcare disparities has failed thus far. We need other models of care, nursing models of care, to be truly effective.

“We realise we have to be on the front foot and not accept the current discrimination.

“The Australian College of Nurse Practitioners is working tirelessly for us and they have our full support. We also know we have incredible support from all the other nursing organisations, with over 40 signatures supporting our protest letter to (Federal Health Minister) Greg Hunt.”

“It is time that the government listened to one of the largest workforces in the country. A blow to us is a blow to the respect of our profession.”