Unleashing the potential of our health workforce – for nurses and midwives

Moderator:

Professor Alison McMillan

Chief Nursing and Midwifery Officer 

Speaker:

Professor Mark Cormack
Independent Review Lead

[Opening visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Chief Nursing and Midwifery Officer, Prof. Alison McMillan PSM’, with an image of Professor Alison McMillan to the left of slide]

[The visuals during this webinar are of each speaker presenting in turn via video, with reference to the content of a PowerPoint presentation being played on screen]

Professor Alison McMillan:

Hello and welcome to this Department of Health and Aged Care webinar focusing on unleashing the potential of our health workforce. My name is Alison McMillan. I’m the Commonwealth Chief Nursing and Midwifery Officer in the Department of Health and Aged Care.

First can I acknowledge the traditional owners of the lands on which we meet and pay my respects to Elders past, present and emerging. Tonight I’m here on the land of the Wurundjeri people of the Kulin nation. Can I also pay my respects as I said and also welcome any First Nations people joining the webinar tonight.

Joining me is of course Professor Mark Cormack who’s leading the review entitled Unleashing the Potential of our Health Workforce which has come about of course as a result of the Strengthening Medicare Taskforce Report.

I thought it was important that we talk a little bit first about the review. The review that Mark is leading is looking at some of the key challenges and opportunities for the primary care workforce across all of the professional streams. We’re looking at how they can work to their full scope of practice and so support our vision for strengthening Medicare. 

So it’s time to remind ourselves about what it was that was the recommendations and the focus of strengthening Medicare and its vision and I think you’ll all agree with me it’s a laudable vision that we would all want to work towards, the vision of all Australians are supported to be healthy and well through access to equitable, affordable, person-centred primary care services regardless of where they live and when they need care, with financing that supports sustainable primary care and a system that is simple and easy to navigate for people and their healthcare providers. So a great vision.

A key recommendation of the Strengthening Medicare Taskforce was coordinated, multidisciplinary teams of providers working to their full scope of practice, to provide person‑centred continuity of care, that including of course prevention and early intervention, and primary carers incentivised to work with other parts of the health system with an appropriate clinical governance to reduce fragmentation, duplication and deliver better healthcare. So not competing between profession groups but looking how we can facilitate working together. And that’s with a focus of course on delivering high quality care. 

I want to welcome Mark Cormack and thank him for making the time to be with us today. Welcome Mark. And also I believe we have Auslan interpreters with us tonight. And also the live webinar tonight – of course it’s live – is live captioned and that’s available by pressing the button on the webinar page to get those live captions. The live captions sometimes struggle a bit with my strange accent but we’ll see how we go working through that.

So I’m going to go quickly and straight away to Mark but firstly let me tell you that of course you can ask us questions. We’ll get to as many questions as we can through this hour session we’ve got today. So at the bottom right hand corner of your screen you should have something that says Q&A. Click on there, type in your question, and then we’ll try to get to as many of those questions as we can during this webinar. But this is only part of a broad consultation process that will be underway the first part of this year.

So Mark you’ve released a review and the first issues paper and that was done on the 23rd of January, this month. You’ve been holding workshops and discussions with stakeholders across the country and I know you’ve been out and about. And this webinar is an important opportunity for nurses and midwives to hear directly from you and of course to ask questions. So I know you want to start by covering off what the review – and I know you’ve got a PowerPoint so I’m going to hand over to Mark who’s going to walk us through the work that has been underway through a PowerPoint presentation on the screen.

Professor Mark Cormack:

[Visual of slide with text saying ‘Scope of Practice Review’, ‘- Phase 2 Consultation Sessions’, ‘Nursing and Midwifery Webinar’, ’27 February 2024’, ‘Mark Cormack, Independent Review Lead’]

Alison thanks very much and thank you all for joining this webinar tonight. Yes. As Alison mentioned we’ve been very busy out and about. We’ve completed kind of an old-fashioned national roadshow. Today I’m up in Darwin. We’ve had 19 sessions very well attended from right across all professions, all interest areas, public, private sector. It’s been a great session. I’ve had over 400 individual conversations on all aspects of this review over the last few weeks throughout the consultation exercise. So I’ll give you just a bit of a run through of where we’re up to and just an inkling I guess into some of the early points that are coming up.

So if I could to the next slide please.

As Alison mentioned the origin of this of course is the Strengthening Medicare Taskforce which went through all the necessary Government approval processes and the scope of practice review was announced in May 2023 in the Federal Budget. Next slide thank you.

We’ve broken the project up into four phases. We’re in the second phase. We commenced in September last year where we’re concluding in October this year. Phase one we received a very large number of submissions and engaged with a very large number of people over the course of the first phase. We’re now in the second phase which focuses on Issues Paper No. 1 and I’ll just describe to you briefly how we got to that point and essentially in the next slide we’ll just take you through what Issues Paper No. 1 is all about and what we’re talking to people about now. Next slide thank you.

So over the course of the first phase we undertook a very large amount of consultation. We had some fantastic inputs from the nursing and midwifery professions, all the various groups there. Had a lot of close engagement with Alison and I’ve really appreciated the support and connection and guidance that Alison has given throughout this process. We received over 700 submissions and consulted with a very large number of organisations in that first phase. We’re drawing to the end phase of a literature and evidence review as well. And the purpose of Issues Paper No. 1 is to draw together our preliminary kind of observations and findings and then structure that in a way that we can get reaction to and comments on which is what we’re doing right now.

So I can summarise Issues Paper No. 1 in terms of five key findings. The first one not surprisingly enabling health professionals to work to full scope of practice supports a stronger primary healthcare system, and equally strong was the evidence to support the second finding that there’s a range of barriers that are actually preventing that from happening. And we don’t really have a primary healthcare workforce that is consistently and equitably able to work at a full scope of practice.

And we call out really three key benefits of a world in which health professionals in the primary care sector are working to their full scope of practice. Firstly the evidence is very clear that it improves consumer access to care. The experience of care is enhanced and the health outcomes from that care are also enhanced. Secondly a well-functioning primary health care system with health professionals working at their full scope of practice reduces the workload for the acute care sector. And thirdly our highly skilled, highly trained, highly regulated and highly committed health workforce really should be working optimally. So the key benefit is maximum utilisation of a very scarce and valuable national resource. It boosts retention and job satisfaction and I guess gives nurses and midwives a reason to keep turning up and to keep contributing to our workforce. And it also creates efficiencies at a system level. Next slide thanks.

The emerging themes from our first round of consultation we’ve grouped into five themes and I’ll step you through those in some detail in a minute. We’ll just go to the next slide.

But equally importantly is that the activities and findings in any one area even if we fully addressed for example legislation and regulation challenges or education and training challenges, there are lots of interconnections and we need to look at this as a whole and not just focus on one area in isolation from another. So interdependency, interaction and impact are really important. And I guess one example that we identified under funding policy reforms is the opportunity for direct referrals by non-medical professionals. And it’s a very good example of it may well be authorised under the legislation that governs professional standards and scope. The workforce is well and truly educated and trained to do that but funding policy does not actually allow that to occur without at least some adverse consequence to the patient. So that’s just probably a good example of the interactions across the themes. Next slide thanks.

And the next one after that. So firstly just looking at theme number one which is legislation and regulation. Obviously they’re key policy levers for scope of practice. And certainly what we identified in the first phase is some inconsistency in regulatory approaches across health professions. We find an abundance of named professions in different Acts, different pieces of legislation and regulation that specify or limit the objectives under those pieces of legislation to named professions. We also identified lengthy and sometimes inconsistent endorsement processes as known barriers to health professionals working to full scope of practice.

We called out four areas for further consideration. Many of these would be longstanding and obvious to you. Harmonising drugs and poison legislation, the potential to look at the national law arrangements and to complement the existing protection of title and named profession approach which is the main feature of our national regulatory arrangements with an emphasis on regulatory processes that look at specific activities and deal with them on a risk-based basis as opposed to a protection of title basis. Looking at some of the inconsistencies and some of the processes in the endorsement arrangements, and endorsed midwives is a very good example where we have a very large requirement for supervised clinical practice that appears to be (a) at odds with other professions and also may not necessarily be as evidence-based as we’d like it to be, and also to look closely at the arrangements that are in place for the self-regulated professions.

And certainly what we’ve identified in our initial phase of consultation is that the legislation and regulatory environment is not actually keeping pace with movements in better practice, emerging service delivery models. For example national virtual hospitals are able to use community paramedics for example in one state but not in another. So we find this sort of tension between innovation and a regulatory system which while it’s effective it seems to take a long time to catch up. And I guess the best example of that is prescribing arrangements across non-medical professions.

A second issue of course is harmonisation and we call that out specifically, and inconsistency across the legislative and regulatory instruments within and across jurisdiction on the same subject, for example a pharmacist in one state is unable to dispense the same range of medications that a pharmacist in another state can do. So that sort of stuff.

We’ll just go to the next slide and look at employer practices and settings. And I guess the key issue here is notwithstanding the fact that we’ve got a pretty mature and well established and fairly open national regulatory arrangement which regulates what 16 professions can do and also the training and accreditation requirements for them to enter that profession. We certainly identify that at the local level, at the health service delivery level, there can be highly inconsistent approaches to enabling nationally regulated professions to do what they need to do at a local level. 

So having overcome ten years ago inconsistent regulatory approaches across states and territories around the core requirements for registration and accreditation we find ourselves with different local interpretations of how those competencies are recognised and translated into what health professionals such as nurses and midwives are able to do in a day to day sense in their work environment. And also the need for models of multidisciplinary care for target patient cohorts to be strengthened and supported by arrangements in place at the local health service level to make that happen and also a very significant gap between the clinical governance mechanisms that support good quality practice in the institutional settings such as hospitals compared to what is available to nurses and midwives and other health professionals in the primary healthcare setting. They’re much less refined and much less supportive mechanisms. So we’ve certainly identified some work that needs to be done to boost awareness right across employer settings and also across the professions about what each of the 16 nationally regulated professions are actually authorised to do under the national regulatory arrangements.

We’ll go to the third slide and this covers off on education and training. And the primary healthcare system has got a proliferation of education and training requirements for competencies across health professions. They differ depending upon how a profession is regulated and also some very significant evidence that access to continuing professional development training is not necessarily consistently supported in practice and also training requirements for similar or common competencies apply inconsistently across professions in some cases. 

So the issues paper outlines a number of potential enablers such as building greater system wide clarity about the requirements of professional entry learning, in particular interprofessional practice. Also we identified a need for a nationally consistent approach to deal with accreditation and regulation of common practices across professions which is different to interprofessional competencies and also the need to incorporate that into post-professional entry learning, ongoing CPD, that while many universities and indeed they’re required to incorporate interprofessional education into their professional entry requirements, that kind of goes by the wayside somewhat when health professionals enter a practice in the real world. So there’s certainly a lot of support for work to be done in that space.

The fourth area focuses on funding policy. And we’ll just go to the next slide thank you. And essentially this is about the payment models that underpin the primary healthcare system. So with the possible exception of the Northern Territory where I am now the overarching and predominant approach to payment within the primary healthcare system is fee for service. And while there are certainly some benefits with fee for service in that it can encourage and reward efficient delivery of health services there are two very, very important things that it doesn’t do particularly well. Firstly for the growing cohort of people with chronic and complex conditions who certainly require a lot of episodic care the fee for service system does not attend to their primary requirements of care planning, care coordination, supporting transitions across the healthcare system from home to clinic, clinic to hospital, back home again, and that kind of lifelong partnership approach that’s required between a person with a complex chronic condition and their primary care team.

So the fee for service doesn’t really cover off on that, neither does it cover off sufficiently on access to multidisciplinary care. That is care that’s provided by nurses, midwives and allied health professions where the arrangements within the MBS system are much more restricted, much more conditional and also tend to have a range of caps, and for a range of services that are provided by nurses, midwives and other health professionals in the primary healthcare system there isn’t really a significant funding or payment mechanism to support that outside of the MBS arrangements.

So we identified a number of enablers there and certainly there’s very, very strong support for the current direction of policy travel in terms of a move away from fee for service into much greater use of block, bundled and blended funding payment approaches to boost flexibility, to support health professionals working to their full scope of practice by having a more flexible, available payment arrangement. Funding and payment types which incentivise working in multidisciplinary care teams and also enabling non-medical professions to be able to make direct referrals to specialists and other consultations rather than having to in all circumstances go back through the GP or the GP gatekeeper model. And certainly a lot of support for recognition of common payment for common service types. So in other words for certain care types a single MBS rate irrespective of which health profession provides that common service type. So again lots of support for that in our consultation rounds.

I’ll just go to the final theme area and this really relates to technology. And this is probably more in the category of an enabler. And certainly many of the changes that we recommend, particularly in relation to direct referrals and support and visibility across a multidisciplinary care team about work that’s undertaken by nurses, midwives and other allied health professionals, will certainly be enhanced when I guess the digital strategy is fully implemented where all team members have real time access to significant events such as referrals, discharges and other important test results and consult reports. Certainly they have been consistently identified as factors that are going to support better multidisciplinary care and also give confidence that health professionals working at their full scope of practice are not practicing in isolation and that work is shared through appropriate digital platforms with all of the necessary consents.

Alison the final slide is really just the next steps and then I’ll just hand back to you and your colleagues. Online public submissions are open now and close on the 8th of March. And submissions can be made through the Consultation Hub or if you prefer to prepare a bespoke submission they would certainly welcome those to the email address on the screen there. We’ve concluded our structured kind of national roadshow so to speak today but we’ll continue with further targeted consultation over the next four to five weeks. We will then begin the focus of drawing together the findings from this phase together with the literature review and prepare Issues Paper No. 2. Issues Paper No. 2 takes many of the ideas that we’ve floated in Issues Paper No. 1 and develops a set of concrete proposals in the legislation regulation space, education and training and employer practices etcetera for much more detailed consideration. That will also be the subject of national consultation and we aim to get a draft final report out and an implementation plan in July for a final round of consultation before submitting the final report to the Minister for Health in October.

So thank you very much for the opportunity to share that with you and very keen to hear from yourself Alison and your colleagues if there are any questions or comments or feedback. Thank you.

Professor Alison McMillan:

Thank you Mark and thanks for that presentation. We’re starting to see some questions come in but I do encourage any of the colleagues that I can see listed in the participants to put their questions forward. Mark to some extent you’ve probably already answered Donna’s question but we’ll explore it because it’s a great question. So Donna says:

Q:        It is clear to me that members of the public including peers and colleagues in health professions have little understanding of what scope of practice actually means.

So Donna is interested to hear our views or thoughts on how this may impact on implementation.

Professor Mark Cormack:

Thank you. Good question Donna and thanks for that. And this has certainly been a very strong theme throughout the current round of public consultations. There is a lot of misunderstanding. I think many people see scope as just this sort of random grab bag of tasks being reassigned across professions as distinct from what health professionals are trained, educated and regulated to be able to perform when they’re given the title of a registered nurse or a midwife. So there’s a lot of work that needs to be done to both explain what scope means and what it doesn’t mean and certainly we attempted that in Issues Paper No. 1 and we’ll certainly further do that in Issues Paper No. 2. 

But at a more practical level this misunderstanding has a very significant impact particularly at the local level about what nurses and midwives are authorised and allowed to do in their day to day employment. So there’s a lot of work to be done. Some of that starts right back when students go in to be trained and educated as health professionals right through to elucidation of standards around interprofessional practice and understanding but also a much more kind of explicit understanding of what the system can expect from a registered nurse, a midwife, an endorsed midwife, a nurse practitioner, etcetera. So a lot of work to be done there.

Professor Alison McMillan:

Thanks Mark. And Donna I’d add to that that during the consultation of the nurse practitioner workforce plan it was really very apparent whether we were talking to consumers or we were talking to other health professionals that there was a clear lack of understanding about the scope of practice of nurse practitioners in Australia despite how long nurse practitioners have been around. But I must say that the feedback generally from consumers was very positive about the enormous trust they have in our professions of nursing and midwifery and that they want care from someone they can trust, someone who will listen to them and someone that will help them with whatever it is that they’re trying to address. And their focus is more on that than actually what professional group delivers that care for them. They’re looking for that. So thanks Donna. Mark the next question is:

Q:        Can you elaborate on the strategies proposed in the first issues paper to enhance collaboration and interdisciplinary teamwork amongst healthcare professionals with obviously a focus on nurses and midwives?

Professor Mark Cormack:

Yeah. Thank you. So I sort of partially covered that in the answer to the first question but I think what we identify in the education and training stream is a much stronger focus on interprofessional education to professional practice. I think that’s a really, really important point. The second point – and it really comes in under funding policy arrangements – I think it’s really important that the benefits that we get from fee for service are complemented through the progressive kind of expansion over time of blended and bundled payment arrangements that enable time and recognition for interprofessional activities, for referral and feedback mechanisms and for multidisciplinary practice. 

And I was quite taken by the session we had today in the Northern Territory where the Northern Territory is a system that for a whole range of reasons, necessity being the mother of invention and innovation, they have a funding mechanism in primary care that’s quite different to the rest of Australia. A lot of the funding arrangements in the Northern Territory are by necessity block funded and blended funded arrangements and what we see is much evidence of stronger kind of teamwork and collaboration because the funding and payment mechanism does not simply drive individual profession by profession activity. It enables a much more holistic and joined up approach. 

So I think that some of the areas we’ll point to will be obviously education and training, greater awareness and understanding, some emphasis on credentialling but also a much closer look at funding and payment methodologies to draw that aspect out.

Professor Alison McMillan:

Thanks Mark. I think Mark the next question is probably for me but I’ll read it out first. And it’s from Tracey. So thank you Tracey for this. Tracey says:

Q:        Nurse practitioners have the widest scope of practice of all nurses and potentially can have the biggest impact on access and equity. However even when a nurse has met the criteria for entry in the nurse practitioner program, has completed the nurse practitioner course and has support from employer for an advanced practice role they may be denied endorsement by AHPRA.

Tracey goes on to say:

Q:        Will the requirements and the process for nurse practitioner endorsement be something that will be looked at by this review?

So I can probably answer that but I’ll let Mark answer after I give my perspective Tracey. Tracey as you know we’ve completed the nurse practitioner workforce plan and some of the issues around how our current endorsement process is structured and required certainly came up during that review process. And I am well aware and hopefully you are too that the NMBA have some pieces of work underway reviewing the accreditation standards of course for the nurse practitioner training and also looking at the standards of practice work. So NMBA have already got that work underway. 

And Tracey the other thing that came out of the nurse practitioner workforce plan was that perhaps an unintended consequence of current requirements were that we drove people more towards highly specialised areas of practice when in fact what we know now is that the generalist is an area that will of course have the greatest impact on access and equity. And so also that’s been taken into account and NMBA are looking at how they can not limit the scope and the work of a nurse practitioner. And also we have recognised that in the Department through the work that we’ve done and so we’re also facilitating through some scholarships opportunities for current nurse practitioners to do additional work that might lead them from perhaps previously a role in acute into a role perhaps in primary care that will give them the opportunity to use that wide knowledge and skill base, work in an autonomous role and certainly be able to contribute to our primary care system that really needs it. 

So that perhaps Tracey somewhat answers your question. So Mark I would suggest that the review will not look at the regulatory standards for nurse practitioners as part of the review but I’ll just leave that to you for a moment to answer.

Professor Mark Cormack:

You’re right and I think you’ve answered the question certainly far better than I could have and obviously with much deeper understanding of the current work program of the NMBA. I guess what we have identified in this area is this kind of importance of kind of consistency in endorsement processes across professions and also – and we use the example of the requirements for endorsed midwives as at face value it looks like a lot is expected to get that endorsement compared with the kind of competencies required of other professions to receive endorsements in other sorts of areas. So it’s really just about consistency and transparency but no we’re certainly not drilling down into the individual regulatory arrangements for individual professions.

Professor Alison McMillan:

Thanks Mark. So hopefully Tracey that answers your question. The next question is:

Q:        Can you provide insights into how the review takes into account the diversity of healthcare settings such as hospitals, clinics and community health and tailor scope of practice recommendations accordingly?

Mark we’ll go to you.

Professor Mark Cormack:

Thanks very much. Look I think it’s early days for us. We’re not quite at the halfway mark but I guess what we have I guess tried to do is first up recognise that the scope of the scope of practice review has sort of been set for us in that it doesn’t really focus on much in the hospital sector. It focuses mainly in the primary healthcare sector although many of the features and aspects of how scope of practice works in the primary care sector may have subsequent applicability in the hospital arrangements. But what we have been trying to do and I have to say I think we’ve made some good progress is to make sure that we get a lot of views, diversity of views across the different sectors. And we’ve certainly found that in both the first and second round of consultations and the current round of consultations that we’re trying to identify different aspects of how scope of practice plays out in large cities versus remote, rural communities, how it plays out in solo practice environments and also in community controlled sectors. 

So we will be making sure that we consult and engage as widely as possible to ensure that it’s not a one size fits all because place does matter. And again just the last day we’ve spent up here in the NT really exemplified that, this sense of how the local context and the cultural context in which care is delivered has an enormous impact on scope and any recommendations that we would want to make to enhance the ability of health professionals that work to scope of practice has to take into account the very significant diversity both geographically and culturally across the health system.

Professor Alison McMillan:

Thanks Mark. The next question from Lydia. Lydia asks:

Q:        Does the review include the enrolled nurses scope of practice?

And Lydia I can reassure you that we are an inclusive review, not exclusive. So we know the important role that enrolled nurses play in our health system and particularly in our primary health system and so yes we see nurses in an entirety, so across a wide range of different type of registration types that nurses and midwives have. So yes Lydia it will.

I’m just going to the next question. The next question is from Shauna.

Q:        Do you foresee any difficulties in embedding these findings into changing individual state and territory legislation to bring them into a national accepted practice?

So Mark I might leave the interjurisdictional question for you first.

Professor Mark Cormack:

Yes.

So this is the short answer but I think the benefit I guess of the approach we’re taking is we recognise – I mean the Commonwealth has some very significant policy and constitutional and funding levers at its disposal but it certainly doesn’t have all of them. And the role of states and territories is very significant in the determination of scope of practice so we have been and will continue to work closely with the states and territories. And there are many mechanisms for us to do that. There’s the Health Workforce Taskforce and we’ve been very consistently engaging with them getting their perspectives. And there are also other mechanisms that are available in the normal federal financial arrangements through the National Health Reform Agreement for example that is currently the subject of significant discussion between the states and territories. And I’m not privy to the detail of that but we’ve certainly been able to provide perspectives and inputs into that process. But any enduring enhancement to the flexibility and the capacity for health professionals to work their full scope will ultimately depend heavily on an effective policy partnership between the Commonwealth and the states and territories. We don’t really see it as a barrier. It’s just the world in which we live and we will be working very closely to work through that as an enabler as much as a barrier. Thank you. 

Professor Alison McMillan:

Mark if I could just add to that that we all know access to universal healthcare is an important thing and states and territories we know from the highest level understand that a primary healthcare system that we describe in that vision will be advantageous to the states and territories. If we have great prevention, good primary healthcare, we will see less impact on our acute hospital system, we can work in partnership together. So I always believe in the positives. So there’s lots of carrots for jurisdictions to want to make this work. It’s seen very strongly by Health Ministers and Premiers about how important this is. So I’m hopeful that there are enough carrots for jurisdictions to want to be able to address some of the barriers we’ve identified but also if we need to there are those levers or sticks that we can use in order to further enable those things as well.

So I think so far the engagement has been really positive and certainly my Chief Nursing and Midwifery Officer colleagues in each of the jurisdictions is very much engaged in this work. So I’m going to stay on the positive that I believe that this is in their best interests and they’ll work with us on that.

Maryanne Grace asks:

Q:        We have small cohorts of endorsed midwives and nurse practitioners who are enabled to work to a full scope of practice. Are we able to support these practitioners to grow in numbers particularly in the rural and remote areas within this practice review?

So Mark I might go to this first and then you can perhaps bring your perspective. So Maryanne I’ve already mentioned the nurse practitioner workforce plan. We are absolutely investing in not only growing the endorsed midwife and nurse practitioners in primary healthcare of course as a Commonwealth focus through scholarships that will be coming forward very shortly to facilitate what is essentially quite an expensive requirement for education. I’ve already mentioned also we’re looking at being able to support nurse practitioners already working perhaps to move into areas of primary healthcare.

And what we do know is whilst you suggest the cohorts are small the cohorts are growing very quickly. This is an area of interest that we are seeing grow in numbers and people are looking for this as an opportunity for them to be able to work as they’d like to. So I think we’re all on a positive pathway in relation to both endorsed midwives and nurse practitioners. As you may be aware we are moving towards removing the legislative requirements for collaborative arrangements. I think a really important message saying that there were legislative requirements, we now acknowledge that they were a barrier to endorsed midwives and nurse practitioners and they’re being removed. And that legislation will be coming forward this year and we’re really excited to see that. 

So I think I hopefully – I regress. If you haven’t looked at the nurse practitioner workforce plan go and check it out because it will show you the commitment there is to grow particularly nurse practitioners. We’re working obviously in the space of endorsed midwives on some of the issues of insurance but we are committed to grow this workforce because we see their importance particularly in primary care.

Mark from your perspective?

Professor Mark Cormack:

Look I think Alison’s covered it well. All I’d add to that is I mean that’s a very good example of a barrier that Alison has just given and certainly the Government is well advanced in the complex steps of undoing that one. And we’ve certainly identified already a number of other potential impediments in the regulatory space, education and training and the employer settings that I think would be very applicable in this area. So it’s very much core business of the review to identify that. And to be frank the biggest and earliest gains in this are likely to be made in rural and remote areas where there is already a thriving innovation and there’s I think a much greater pragmatic kind of acceptance of let the nurses nurse and let them do their job properly. There are great community benefits from that. So I think rural and remote will be very much kind of early adopters hopefully of whatever successful kind of policy and issues might come out of this review.

Professor Alison McMillan:

Thanks Mark. The next question is from Leanne. Leanne says:

Q:        It’s important to consider how this work aligns with other current work including strengthening Medicare, the nurse practitioner and nurse workforce plans and other MBS and health related reviews underway. We can see a lot of emerging and consistent things. Can you speak a bit about how the scope of practice review is working alongside and in conjunction with these?

Mark?

Professor Mark Cormack:

Yeah. Thanks Leanne. Really good question. And in fact pretty much before I signed up for this job I was mightily kind of (a) initially concerned but (b) impressed by the number of related initiatives that are underway. And I have to say that certainly from the Department’s perspective they’ve got some very strong internal coordination mechanisms. They’ve got an internal reference group that is providing governance oversight to make sure that all these different measures under the strengthening Medicare, and even those that aren’t under the strengthening Medicare, some are just in the workforce space, are joined up and connected. I meet regularly with the governance committees, the senior officials and the leaders of a number of these initiatives and reviews so we are very, very much aware of working collaboratively across these reviews, making sure that each review, each measure, each planning endeavour we’ve got a high level of awareness of and that we’re coordinating closely. 

So it’s an area of constant vigilance and I think that if we can get all these things joined up, and that’s certainly my intent, then I think we’re going to get a much better result. And I can only assure you that the owner of every other related business activity shares exactly the same view. They want this thing joined up and woven into a delicate quilt rather than a rough patchwork.

Professor Alison McMillan:

Thanks Mark. And Leanne I recognise very much your contribution – that’s Leanne Bows – to this work. You have been raising many of the questions we’re seeing through all of these reviews for a long time. In some ways it’s somewhat reassuring that many of the same emergent things are being raised through these different reviews. So we do have consistency and therefore we potentially will be able to address many aspects of this through the work that you’ve been committed to for a long time and that we’re all working to a positive outcome. So that’s good.

And obviously Mark’s team and my team and many of our colleagues across the Department, we do collaborate very closely.

Sorry. Excuse me for leaning forward but the print is really small. So the next question is from Lisa.

Q:        During the review process has there been feedback in relation to the scope of undergraduate nursing students working as unregulated care providers? This can very much enhance student skills and knowledge and may support cost of living pressures.

So Lisa I’m happy to go to Mark in a moment but I’m not sure that the review will look necessarily at the scope of undergraduate students working in care provider roles which we know is often how they maintain their income during their training and we know that in some jurisdictions we have what we know as RUSONs. The issue of cost of living associated with undergraduate students is being tackled through the University Accord and other reviews that are currently underway. But it’s certainly recognised as a key issue and it’s certainly emerging in our work through the National Nursing Workforce Strategy. So it’s front of mind and we’re well aware of some of the challenges that our current students are seeing and the importance for addressing some of those. So Mark is there anything you wanted to add to that?

Professor Mark Cormack:

No. I think you’ve covered that well. Thank you.

Professor Alison McMillan:

Okay. The next one is from Julia.

Q:        Do you think the review will create strategies and recommendations around specific approaches to legislation to change to ensure broader health professionals are recognised to complete care and tasks that the health practitioner is competent in?

I’ll go again. Sorry Lisa. Because I’m reading the questions as they’re going.

Q:        Do you think the review will create strategies and recommendations around approaches to legislation to change – I guess change legislation – to ensure broader health professionals are recognised to complete care?

Mark?

Professor Mark Cormack:

Yeah. Thank you. Yes. Look legislation is a really major lever here. So it is highly likely that we’ll be making some specific recommendations around first up the principles that underpin the legislation. And that includes not only the national law arrangements for regulation of health professionals but also other legislation that has an impact. And it’s one of our five themes and we’re already in the early stages of thinking what some of those could be and could be further explored. So I guess the summary answer is it’s yes highly likely that we’ll be making some recommendations there. But making changes to the legislation is not straightforward. It requires time. It requires a lot of engagement and consultation. And in this space almost all of it has Commonwealth/state interactions and we need to make the necessary time and do the necessary consultations to progress those sorts of recommendations. But it’s a very important part of the work and yes there will be some there.

Professor Alison McMillan:

Okay. The next question is from Anne and Anne asks:

Q:        Will the review consider the number of medications that cannot be prescribed by a nurse practitioner and limiting the holistic care we should be able to deliver?

So Anne I would say you will have heard from Mark that we are looking at a range of legislative and regulatory arrangements that can create barriers to all health professionals working to their full scope of practice. And obviously some of these – you may be aware Anne or you may not and if you’re not check on my web page because we are talking about some of the work that’s already underway. So my office is already working with colleagues in the Department and the PBAC with great assistance from the College of Nurse Practitioners to already review the number of medications that nurse practitioners and endorsed midwives can prescribe under the PBS. So what’s within our Commonwealth scope we’ve already got that work underway and we really appreciate the help of the Australian College of Nurse Practitioners and the Australian College of Midwives in that work. That work is underway so again engage with it. That’s only a part of it. That’s the PBAC.

Obviously some of the other legislative barriers that prevent you if you’re a nurse practitioner from prescribing medications relate to the drugs and poisons regulations which definitely has emerged in every aspect of the consultation I’ve heard and it certainly emerged on a number of occasions and the number of sets of arrangements. So we’re considering it. It’s certainly coming forward and I think it was actually mentioned in Mark’s slides at the beginning about one of the themes of legislation regulation. But Mark’s work is really important but it doesn’t mean to say we haven’t got other work underway. But Mark anything you want to add to that? 

Professor Mark Cormack:

I think you’ve covered it well. Just to say we won’t be making specific scope change recommendations. That’s out of scope for our terms of reference. Ours is a principle-based review and we certainly won’t be getting down to the detail of making recommendations around specific treatments or specific medications or specific schedule changes, those sorts of things. Ours will be more looking at the systemic and policy underpinnings rather than individual professions’ detailed scope of practice or professional standards.

Professor Alison McMillan:

From Adrian.

Q:        The review is a very needed thing.

Is what Adrian’s saying.

Q:        With a focus on flexibility in roles for RNs and ENs. The question is will there be sufficient resourcing in our universities to educate in areas of need noting COVID has significantly impacted our universities and many are still rebuilding their faculties. Do you see a challenge in this area?

So Adrian we know that there are many challenges in our professions at this point in time in the resourcing and capacity across our system. So what we know is that – and that’s part of the work that we’re doing in the National Nursing Workforce Strategy is looking at our profession of nursing in its entirety. And that of course includes the capacity of our education system to meet the current and future needs of our professions, and that is part certainly. So I’d suggest it’s more in the scope of the National Nursing Workforce Strategy rather than work that Mark is looking at. But that doesn’t mean to say that as I’ve said before that we’re not working together to make sure that where there’s synergies of issues that we’re not addressing those. And I think you’ll probably find that the University Accord is also looking at areas of this. The final report was published I think yesterday. 

So Mark thank you. I’m sorry we didn’t get to everyone’s questions. They all came in a big flurry at the end. But any final comments from you Mark before we close off and all go home for dinner?

Professor Mark Cormack:

No. Thanks for the opportunity. Enjoy your evening and I look forward to working with Alison, the great team in her office and also all of the nursing and midwifery groups across the country. Thank you.

Professor Alison McMillan:

Thanks Mark. And my final words are your voices are really, really important. Please in order for us to bring forward all of the reform that we’re looking for in our professional groups we do need to contribute and we need to be part of the conversation. So please make sure you take the opportunity when it comes to you to be part of consultations, making submissions, working with your professional and peak bodies in order that they can represent your views as well. But I can reassure you that the voices of nurses and midwives are being heard very clearly across our system and that’s a credit to all of what you do every day in whatever role you fulfil in our health and aged care system. 

So thank you for coming at this time of the evening. I wish you all a good evening and I look forward to hearing from you again in the very near future. Thanks Mark and thanks to the team for organising the webinar. It’s great work. 

Professor Mark Cormack:

Thank you. Cheers.

[Closing visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Chief Nursing and Midwifery Officer, Prof. Alison McMillan PSM’, with an image of Professor Alison McMillan to the left of slide]

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