Twelve national organisations are calling for immediate reform to Medicare and pharmaceutical policy settings that are delaying diagnosis, fragmenting care and driving avoidable hospital admissions in the bush.
The peak bodies representing nurses, nurse practitioners, endorsed midwives, and midwives, together with health system experts, have written jointly to the Senate Standing Committees on Rural and Regional Affairs and Transport, warning that current settings are materially compromising timely access to essential health care across rural, regional and remote Australia.
The group is warning the consequences of recent policy changes are "no longer theoretical," with services reporting disrupted care pathways, delayed clinical reviews and increasing strain on already fragile models of care.
"Reform is not optional," said Adjunct Professor Chris Helms of the Australian College of Nurse Practitioners. "Without urgent correction, current policy settings will continue to compromise safety, sustainability and equitable access for rural, regional and remote Australians."
"These settings are no longer administrative inefficiencies – they are contributing to delayed diagnosis, fragmented care, avoidable hospital escalation and inequitable outcomes for high-risk populations," said Adjunct Professor Helms, who signed the letter on behalf of the group.
The signatories highlight the 12-month face-to-face requirement for Nurse Practitioner Medicare Benefits Schedule telehealth services as a particular concern, noting that for many rural, regional and remote Australians, telehealth is not a convenience but the only clinically viable pathway to continuity of care.
Patients are experiencing delayed reviews, postponed investigations and fragmented follow-up solely due to funding restrictions. The group warns these impacts are especially serious in oncology surveillance and survivorship care, complex mental health follow-up, chronic disease management and palliative care.
In addition, nurse practitioner- and midwife-led practices remain ineligible for MyMedicare registration, excluded from Bulk Billing Incentive Programs, locked out of key advanced diagnostic and procedural MBS items, and without appropriate rebates for after-hours and on-call services.
"It is inconsistent to promote workforce expansion through the Commonwealth's Nurse Practitioner Workforce Plan while structurally limiting the funding mechanisms that enable that workforce to practise sustainably," the letter states.
The group also calls out the exclusion of Nurse Practitioners from the Repatriation Pharmaceutical Benefits Scheme (RPBS), which forces Department of Veterans' Affairs patients to transfer to alternative prescribers solely to access subsidised medications – disrupting established therapeutic relationships for administrative reasons alone.
The signatories are calling for eight urgent reforms:
- Immediate review of the 12-month telehealth requirement in rural, regional and remote contexts,
- Inclusion of nurse practitioner- and midwifery-led services in MyMedicare,
- Eligibility for the Bulk Billing Incentive Program,
- Removal of outdated collaborative model requirements in Urgent Care Centres,
- Access to advanced diagnostic, procedural and referral MBS items consistent with scope of practice,
- Inclusion of Nurse Practitioners in the Repatriation Pharmaceutical Benefits Scheme,
- Structured MBS support for chronic disease, mental health, maternity and after-hours care delivered by nurses and midwives,
- Mandatory rural, regional and remote impact stress-testing of all future Medicare reforms.
The full joint letter is available on request.
Signatories: Australian College of Nurse Practitioners • Australia and New Zealand Urological Nurses Society • Australian College of Mental Health Nurses • Australian College of Nursing • Australian Primary Health Care Nurses Association • Cancer Nurses Society of Australia • College of Emergency Nursing Australasia • Congress of Aboriginal and Torres Strait Islander Nurses and Midwives • CRANAPlus • Drug and Alcohol Nurses Australasia • Gastroenterological Nurses College of Australia • Synapse Medical Services
