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The good, the bad and the ugly: Nurse Practitioners and the politics of health care The good Nurse Practitioners (NPs) are highly educated health care professionals and the only advanced practice nurses recognised and regulated by the Nursing and Midwifery Board of Australia. The purpose of implementing the NP role was to improve the flexibility of the Australian health care system and increase patient access to health care1 . The endorsement of the first two Australian NPs took place in December 2000, and now over 22002 NPs provide comprehensive patient care across a diverse range of health care continuums3,4. Through collaborative, safe, and effective care, the NP provides value-based health care across the public and private health care sectors5 . In 2009, then Minister for Health Nicola Roxon, led historic health reform resulting in the Health Legislation Amendment (Midwives and Nurse Practitioners) Act 2010. This legislation enabled patient access, albeit limited, to the Medical Benefits Schedule (MBS) and the Pharmaceutical Benefits Schedule (PBS) for eligible NPs6 . As a result, private patients choosing to see an NP for their health care can claim limited Medicare subsidies for services and medicines arising from NP-directed care in primary health care settings. The MBS and PBS reforms have truly been transformative for the Australian NP role. No longer restricted by often rigid public sector NP models of care, that limit nursing scope of practice and innovation7–9, NPs are increasingly moving to the private sector to actualise the full potential of their roles and explore innovative models of care10. The bad More than a decade later, of the 5700 items listed on the MBS, patients are still limited to a handful of subsidies for NP-directed care11. These include subsidies for face-toface and telehealth consultations, a comprehensive array of diagnostic pathology items, limited diagnostic imaging requests and limited pointof-care tests performed by NPs11. Evidence suggests NPs often achieve the same or better outcomes in delivering primary care services compared to doctors12,13. Despite this, the Australian government uses taxpayer dollars to increase subsidies for patients seeking care from doctors, thereby giving the medical profession an unfair market advantage over NPs providing those same services. After ten years of participation in the MBS and PBS, there is no evidence that suggests services performed by NPs are inferior, unsafe or ineffective when compared to doctors. One has to ask why the Australian Department of Health (DoH) refuses to broaden the scope of subsidised services offered by NPs. The answer may lie in the lobbying influence of medical associations influencing DoH bureaucrats to assist with turf protection for the financial benefit of doctors and not the benefit of patients14. When looking at consultations alone, MBS subsidies are over 50 per cent higher for general practitioners, who are also afforded additional Editorial note: The authors of this paper have asked to have their names withheld. The JPN editorial team do not usually agree to such requests, but we have made an exception in this case. As you will read, there is significant animosity between Nurse Practitioners and the federal health bureaucracy. Real or otherwise, the authors fear potential reprisals for calling out what they see as prejudicial behaviour against their community. Guest editorial e-2 Journal of Perioperative Nursing Volume 34 Number 4 Summer 2021 acorn.org.au incentives for ‘bulk billing’ their patients. Bulk billing transfers the patient’s subsidy directly to the health practitioner. No special incentives exist for NPs who bulk bill their patients. Such Australian government policies assure
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