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that only the medical profession can provide universal health care through bulkbilled MBS services. The existing MBS subsidies ensure that bulk-billing NPs can neither sustain themselves financially nor practise independently. To maintain financial viability, NPs are increasingly passing the costs of care provision onto patients. In effect, the Australian DoH is consciously shifting health expenses to the consumer regarding NP-related primary health care, as it is nearly impossible for NPs to earn a living on a bulk-billed income alone. Current MBS subsidies limit patient access to health care and, for some patients, remove the choice of who delivers their health care. Attempts by NPs to change the limited access to the MBS include 14 evidenceinformed primary health care recommendations compiled by the Nurse Practitioner Reference Group (NPRG)15 for the MBS Review. There were also numerous professional body and individual clinician submissions to the MBS Review. In their capacity as representatives of peak professional bodies, NPs and many other nursing leaders met many times with government to lobby for broadening MBS subsidies to address crucial health care shortfalls. All of these attempts have been unsuccessful16. Of note, the membership of the MBS Review Taskforce had no representation from the nursing profession and consisted almost entirely of medical practitioners, except for one policy expert and one health consumer. Medical associations representing medical practitioners have clearly articulated their position on the NP role. These positions are not supported with evidence but with the use of misinformation and scare tactics17–19. Compounding this situation are press releases outlining how the Australian government and medical associations are working together to co-design administrative processes to support future changes to the MBS, which leaves little confidence that the patients of NPs will receive fair subsidies20. The experience of NP surgical assistants also demonstrates the notion of a medico-centric approach to administering the MBS by the Australian DoH. Aside from input into the MBS Review process, the NP surgical assistants have unsuccessfully tried to navigate the Medical Services Advisory Committee (MSAC) process. The role of MSAC is to appraise health care services for public funding21. NP surgical assistants have demonstrated they offer an effective22 and legitimate23 alternative to medically qualified surgical assistants and increase patient access to surgical care24. Yet, attempts to gain access to the MBS surgical assisting patient rebates via applications to the MSAC committee have failed. Both applications failed in the pre-assessment phase. Like the MBS Review Taskforce, the MSAC committee has no nursing representation, with 16 of the current 21 positions occupied by medical practitioners. At face value, the above observations appear anti-competitive in nature. This proposed anti-competitive culture of the Australian DoH makes one wonder if the Competition and Consumer Act 2010 applies, or if the powers of the Australian Competition and Consumer Commission (ACCC), the independent statutory authority that enforces the Act, pertain to those administering the MBS. The ACCC is investigating if the Australian DoH has a case to answer. The ACCC has also suggested that the Commonwealth Ombudsman may be an alternative avenue for NPs to consider. The role of the Commonwealth Ombudsman is to assure that Australian Government entities act with integrity, treat people fairly and influence improvements in public administration25. The ugly Failing meaningful intervention from the ACCC or the Commonwealth Ombudsman, the law of torts may be a final possibility. Torts law is concerned with awarding damages to individuals to repair the harm caused by a breach of obligation26,27. The tort of misfeasance applies to a person occupying a public office who exceeds or abuses public power28 or breaches their obligations27. Two points for consideration here are: 1. that occupancy of public office implies a public position, but this is not limited to those appointed to a statutory office; there is no definitive test to
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