From November, nurse practitioners will be subject to the same 12-month existing relationship rule of telehealth as GPs – a move some say will disadvantage patients.
The 12-month existing relationship rule for telehealth should be scrapped all round in the interest of patients, a prominent nurse practitioner is arguing.
Australia currently has around 3000 nurse practitioners on the registration books, with the biggest recent change being the 2024 removal of the requirement to have a collaborative agreement with a doctor in order to access MBS and PBS patient rebates.
On 1 November this year – exactly 12 months after the collaborative arrangement requirement was lifted – there will be another major change to the regulations.
As recommended in an MBS Review Advisory Committee report last year, nurse practitioners will be subject to the same existing relationship rule for telehealth appointments that is currently applied to GPs.
Under this rule, a practitioner cannot bill the MBS for a telehealth appointment with a patient they have not seen face-to-face in more than 12 months.
GPs and nurse practitioners will be the only practitioners subject to this rule; non-GP specialists and other eligible allied health professionals can still technically bill the MBS for telehealth appointments with patients they have not met face-to-face.
Amanda Butt, a nurse practitioner working in mental health, said that applying the existing relationship rule was a misinterpretation of the role nurse practitioners played within the health system.
“I have a lot of [nurse practitioner] colleagues who specialise in women’s health and endocrinology and cardiology and neurology,” she told The Medical Republic.
“[They see patients who] are referred on from GPs, and GPs seek out assistance from the nurse practitioners specialising in that care.
“It works a little bit differently, which makes it harder to establish a face-to-face relationship with someone first … we don’t expect that of psychologists, we don’t expect that of physios.
“We don’t expect that of any other health professional, and we shouldn’t really need to do that with GPs as well.”
Ms Butt has submitted a parliamentary petition on the matter, requesting a review of the law for nurse practitioners. The petition is currently awaiting approval.
One of her arguments is that, as it currently stands, nurse practitioners will not be able to access the exemptions that apply to general practice.
There are some mental health planning and treatment item numbers which are exempt from the 12-month rule, meaning GPs can bulk bill certain patients they have never met face-to-face.
Currently, nurse practitioner phone items only extend to four time-based item numbers.
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“It’s hard to give nurse practitioners [telehealth] exemptions like [those for] GPs, because nurse practitioners don’t have specific item numbers for mental health, we only have our timed item numbers,” Ms Butt said.
“GPs have mental health item numbers, so if they claim that as a telehealth then it’s okay if they haven’t seen the patient face-to-face, because it’s a mental health consult.
“[I have heard] a government official say, in those words, that it’s just too hard to implement item numbers for nurse practitioners in mental health, and that’s why we haven’t been afforded the same exemption as GPs.”
Australian scope of practice discussions thus far have tended to centre on pitching one particular profession as a replacement for another, rather than recognising the unique contributions of each profession.
In other words, nurse practitioners should not necessarily be treated as mini-GPs by the government.
“We’re not … doctors, we’re nurses, and we’ve never said that we are doctors in any way, shape or form,” Ms Butt said.
“I had a discussion with a GP recently about this … they say, ‘well, we’ve gone through medical school, you know, we’ve done the hard yards’.
“There’s this fallacy of understanding [as if] we didn’t go through any hard yards.”
The pathway to becoming a nurse practitioner involves a three-year base degree, followed by several years working as a registered nurse and completion of a graduate diploma before entering into a master’s degree, which tends to require about 5000 hours of advanced practice.
“That, all up, is at least 10 years before a nurse practitioner is practising on their own,” Ms Butt said.
“So we’re not talking about medical school, but this is nursing with [added] education.”