GPs needed to inform nurse practitioner arrangements



A review is underway to shape best practices in collaborative care and clearly define integrated roles, and the College is seeking member input.

The RACGP asks for more clarity on the roles in the collaborative agreements with nurse practitioners.

The role of nurse practitioners within primary care teams has, to date, been the subject of competing recommendations regarding clinical scope of practice and responsibilities.

In 2019, the Nurse Practitioner Reference Group (NPRG), a subcommittee of the MBS Review Taskforce, released a report outlining recommendations for Medicare elements related to nurse practitioners.

In response, the RACGP issued a submission, opposing the main recommendations of:


  • expanding the scope of practice of nurse practitioners to provide Medicare-funded services
  • remove current requirements that nurse practitioners must collaborate with physicians to provide patient care
  • create and expand new Nurse Practitioner Telehealth articles.

Although the task force did not endorse any recommendations from the NPRG report, it made three independent recommendations to address outstanding issues, one of which was an independent review of nurse practitioner collaborative arrangements.

Commissioned by the Department of Health and currently underway, the review strongly supports collaborative arrangements to ensure patient safety. It aims to better understand what current processes are working, what can be improved, and what collaborative arrangements should look like in the future.

As part of the review process and to allow GPs, nurse practitioners and midwives to contribute, feedback is now being sought via an online survey until June 26.

The RACGP urges members to participate in the survey to ensure that the role of general practitioners in collaborative agreements and the College’s position on nurse practitioners are clearly defined.

The survey results will also help in part to inform a new submission the College is preparing for the review of collaborative arrangements with nurse practitioners.

Professor of general medicine Dimity Pond is a consultant on this submission. She said newsGP that GP feedback is valuable in shaping the results of the review.

‘GPs who have participated in the collaborative arrangements have significant experience of the strengths and weaknesses of this system,’ Prof Pond said.

“Nurse practitioners are important members of the primary care team. We need to work together to optimize health care for our patients, and this review is important for that.

Established in 2010, the Collaborative Agreements provide guidance on nurse practitioner roles and responsibilities for referral, consultation and record keeping. However, the existing provisions do not refer to the scope of clinical practice.

“During the review, account should be taken of the responsibilities of the other parties in
collaboration to ensure that referrals are made within the defined clinical scope of practice of the nurse practitioner so that patients receive safe and appropriate care,” state the findings of the report of the task force on the review of the MBS.

Concerns had previously been raised by GPs over proposals to allow nurse practitioners to practice independently in the primary healthcare sector, while pressure to open nurse-led clinics in some states have encountered resistance around costly and fragmented models of care.

The RACGP supports nurse practitioners as part of a general practitioner-led practice team, noting in a recent submission to the Nurse Practitioner 10-Year Plan that while their role should be embedded in collaborative agreements, the provision of care outside of a patient’s regular GP will lead to fragmentation and should be offered as an “add-on service” to GPs.

Additionally, in its position statement, the college states that “independent nurse practitioners who seek the same level of authority, autonomy and scope of practice as general practitioners will compromise the quality, safety, effectiveness and the cost-effectiveness of patient care”.

According to the RACGP, the clinical settings in which patient care will be provided must be clearly identified in collaborative agreements, and general practitioners must liaise with nurse practitioners regarding responsibilities and scope of practice agreed upon during the conclusion of a collaboration agreement.

Professor Pond agrees.

“Well-structured collaboration agreements that clearly define roles and responsibilities while allowing each team member to support the other are potentially very helpful in this space,” she said.

General practitioners can complete the online survey until June 26, or by e-mail [email protected] for any additional comments that may be considered for RACGP’s response to the survey.

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