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Monday, 7 September 2009
Page: 8735


Ms NEAL (8:20 PM) —I have to say that was certainly a stimulating and empowering speech from the member for Ryan. Well done! I rise in the House today to speak in support of the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009. This bill amends the Health Insurance Act 1973 and the National Health Act 1953. It formalises legislation already in place in many states and territories, recognising the role of midwives and nurse practitioners in the provision of primary health care. The bill provides patients under the care of nurse practitioners and midwives access to the Medicare Benefits Schedule. It is a great step forward and something not recognised by many speakers on the other side. It also allows these eligible nurses and midwives to prescribe certain medications subsidised under the Pharmaceutical Benefits Scheme.

The focus of this bill is, first, to increase the capacity, effectiveness and efficiency of the healthcare system and, second, to encourage a multidisciplinary team approach to primary care. The minister has said that nurses and midwives are the backbone of the healthcare system, and this is completely and utterly true. This bill provides for long overdue recognition of the full scope of their capacities and contributions to primary health care.

I am aware of concerns that have been raised by members of the community regarding the effect of this legislation on homebirth midwives. I myself had two births attended by midwives, not through planning but because the doctors did not get around to being there. But I have to say that I was probably lucky. I have been contacted by Central Coast residents such as Lisa Cuthbert, who has expressed her support for midwives in private practice and the service that they provide to some women in the community. This bill has always been about improving choice and extending Commonwealth funding for a range of midwife and nurse practitioner services—for the first time ever including providing antenatal care in the community and attending births in clinical settings.

I would like to commend the Minister for Health and Ageing, Nicola Roxon, for achieving agreement from all health ministers around the country to a transitional clause in the current draft national registration and accreditation scheme legislation—no mean feat in the present circumstances. This transitional clause provides a two-year exemption, until June 2012, from holding indemnity insurance for privately practising midwives who are unable to obtain professional indemnity insurance for attending a homebirth. In other words, there is an opportunity and a time delay to allow midwives to arrange appropriate indemnity insurance. The agreement provides a framework for collecting invaluable data and facilitating cooperation between different levels of government to move this sector forward. It also goes a long way to allaying community concern about the rights of women to choose the place and support that they want when they give birth. The minister’s swift and responsive actions have gone a long way to resolving concerns raised by midwives on this matter.

Today, however, I will focus on nurse practitioners and their vital role in primary care in the context of this bill. This bill enacts the government’s 2009-10 nurse practitioners workforce budget measure, worth $59.7 million. Expanding the role of nurse practitioners in the provision of primary care has a particular significance for the electorate of Robertson. The New South Wales Central Coast Division of General Practice, which covers most of my electorate, reports that GP-patient ratios are at one to 1,140. This appears to be a favourable figure when compared to the national average of one GP for every 1,404 patients recorded in 2003-04. However, in Robertson we have a population in which 18.6 per cent of people are aged over 65 years. The national average for the same age group is 13.2 per cent around the rest of Australia. Clearly the Central Coast of New South Wales attracts a higher proportion of retirees. In assessing the impact of this concentration of older Australians, it must be highlighted that this additional population of seniors brings with it a more intensive and regular demand on primary healthcare services. Accordingly, the impact on Central Coast GPs’ time from this age group is disproportionately high compared to that for the average member of the Australian national population. It means more complex, chronic and high-need patients per head of population than the national average.

Nurse practitioners have a vital role to play in addressing this increasing need for care in our ageing population. I know that in my electorate of Robertson, on the New South Wales Central Coast, the changes brought about in this bill will be warmly welcomed by hardworking healthcare services. They work overtime to provide adequate primary health care to patients in residential areas such as Gosford, Erina, Kincumber and Terrigal and on the Woy Woy Peninsula. Dr Jeremy Bramston is one of those hardworking general practitioners in my electorate, and he has said, ‘Co-locating general practitioners and registered nurses provides the most effective team to deliver the broadest range of treatment and medical support to patients.’ Of course, he is right. His general practice in Woy Woy on the New South Wales Central Coast, just 10 minutes from my home, already employs nurses to complement the work of the resident GPs. This one practice sees over 2,000 patients per week, and the contribution of nurses in the mix of healthcare practitioners is warmly acknowledged.

This model reflects the intention of the bill, which is to foster and expand the uptake of a collaborative, multidisciplinary team approach to the provision of primary health care. I offer two scenarios to demonstrate how this collaborative and multidisciplinary approach expands the capacity of the primary healthcare system, an obvious focus of this federal government. The differing but complementary skill sets of doctors and nurse practitioners are what make this team approach so important.

Firstly, by acknowledging the talents of nurse practitioners in the area of patient education, improvements can be made in health outcomes for patients with long-term chronic medical conditions. For example, suppose a patient walks into a general practice and is diagnosed by a doctor as having diabetes. That patient then spends time with a nurse practitioner to talk over what adjustments the patient must make to manage their condition in conjunction with the prescriptions provided by the GP. This patient is then able to return to the registered nurse with questions, and there can be follow-up testing and advice on managing that diabetes. This would occur in the context of the co-located doctors and nurse practitioners, with diagnostic oversight continuing to be the responsibility of the treating doctor. By drawing on a nurse’s undeniable educational skills to assist the patients with the ongoing lifestyle adjustments that accompany a diagnosis such as diabetes, the demands upon a GP are eased. The patient benefits from the communication and education skills that come as part of the nurse practitioner’s training. Arrangements such as these have the capacity to greatly boost a patient’s understanding and treatment of ongoing symptoms, complex care needs and prescriptions as well as expanding the capacity of the primary care system to meet increasing demand.

A second example relates to maximising doctor time in diagnosis and the skills of nurses in ongoing management and record keeping. The hours dedicated by doctors to visiting aged-care facilities are time-limited due to the various constraints from attending to the patient workloads in their surgeries. In aged-care facilities, where a diagnosis occurs, paperwork for that patient must be filled out in triplicate. A script must be written and notes made at the care facility and then duplicate notes for the same patient made back at the doctor’s surgery. In circumstances such as these, nurse practitioners spend time in nursing homes—


The DEPUTY SPEAKER (Hon. KJ Andrews)—Order! It being 8.30 pm, the debate is interrupted in accordance with standing order 34. The resumption of the debate will be made an order of the day for the next sitting. The member for Robertson will have leave to continue speaking when the debate is resumed.