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determine what incorporates public office 2. the notion of public law obligation considers public officials owe a duty of care not to abuse their powers29. Misfeasance is ‘the wrongful performance of a normally lawful act; the wrongful and injurious exercise of lawful authority’30. This tort does not apply to everyone employed by a public authority; the courts have outlined that the public official must have a significant position with relevant power and accountability to the plantiff27. To establish the tort of misfeasance, the plaintiff must prove that in the alleged discharge of the public official’s duty, their act was invalid or unauthorised, malicious and caused harm to the plantiff31. Journal of Perioperative Nursing Volume 34 Number 4 Summer 2021 acorn.org.au e-3 The MBS Review Taskforce aimed to align the MBS with contemporary clinical evidence and practice by providing recommendations for reform to the Minister for Health. The aims were to support affordable and universal access, best-practice health services, value for the individual patient and value for the health care system15. The MBS Review Taskforce did not endorse any recommendations from the NPRG but did propose three ‘alternative’ recommendations without any evidence or rationale to support them. This action was outside the MBS Review’s terms of reference and highlighted not only poor Australian DoH governance processes but also the genuinely medico-centric nature of the MBS Review process. Members of the MBS Review Taskforce were in significant positions of power and had accountability to patients and NPs, not solely medical practitioners. The taskforce was predominately comprised of medical practitioners engaged by a medicocentric DoH. Members of the taskforce had many opportunities to discuss and engage with NPs and nursing groups, who highlighted the importance of both comprehensive MBS access for patient care and reduced out-ofpocket expenses. The failure of the taskforce members to recognise these highly skilled health care professionals and ignore the evidence they provided has impacted many NPs’ mental health. Their primary source of distress relates to their patients who, due to the current MBS restrictions, cannot access subsidised health care and have sometimes experienced unacceptable delays or duplication in care that has contributed to patient harm, as well as breaches in patient confidentiality. Disregarding NPRG recommendations and proposing irrelevant substitute recommendations, knowing these would restrict the NPs ability to provide patient care, may enable action in misfeasance against taskforce members. Finally, one should note there may be unintended consequences to the staunch resistance of the medical lobby to patient subsidies for NPdirected care. Medical turf protection and non-collaboration may ultimately result in a parallel system of primary health care providers, who actively compete for the patients and businesses of high-paying health consumers. This can be seen with NPs who are turning to niche specialty practices funded solely by out-ofpocket payments because they can’t earn a living serving the marginalised populations they were educated and trained to care for. This serves no one, with losers on both sides. References 1. Australian College of Nurse Practitioners. Response to MBS Taskforce Review. Communication to The Honourable Greg Hunt MP, 2021. 2. Nursing and Midwifery Board of Australia (NMBA). Registrant data – Reporting period: 01 January 2021 to 31 March 2021 (p.9) [Internet]. Canberra: NMBA; 2021 [cited 22 August 2021]. Available from: www.nursingmidwiferyboard.gov.au/About/ Statistics.aspx. 3. Helms C, Gardner A, McInnes E. Consensus on an Australian Nurse practitioner specialty framework using Delphi methodology: Results from the CLLEVER 2 study. J Adv Nurs 2017;73(2):433–447. 4. Currie J, Chiarella M, Buckley T. Workforce characteristics of privately practicing nurse practitioners in Australia: Results from a national survey. J Am Assoc Nurse Pract 2016;28(10):546–553. 5. White J, Thoms D, Bryant R, Chiarella M, Morton L. Medicare Benefits Schedule Taskforce Review. Communication to The Honourable Greg Hunt MP, 2020.
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