As part of an ongoing review of PBS prescribing by nurse practitioners and endorsed midwives, the Pharmaceutical Benefits Advisory Committee (PBAC) has been investigating the subset of PBS listings for nurse practitioner prescribing that are subject to a Shared Care Model of administration.
The PBAC noted that the issue of nurse prescribing has been complicated by the separate arrangement for PBS prescriptions in certain public hospitals which are not documented by the Committee, with individual guidelines issued by the hospital for specific modalities, such as Fiona Stanley’s Antenatal Shared Care procedures.
Similarly, the medicines which they can prescribe differ between states and territories and it is the nurse practitioner’s responsibility to ensure they adhere to any State laws governing prescriptions (PBS and private) and PBS requirements.
“This work is in the context of the legislative changes occurring on 1 November 2024, whereby there will no longer be a requirement for nurse practitioners and endorsed midwives to have specified collaborative arrangements with medical practitioners,” Ms Jo Watson, the PBAC’s Deputy Chair explained.
“The PBAC recognises that current professional practice standards, settings of care, and an individual’s scope of practice will largely determine the degree of collaboration among health practitioners.”
Scope of practice for nurse practitioners, endorsed midwives, nurses and midwives is currently defined by the Nursing and Midwifery Board of Australia and, nationally, nurse practitioners and endorsed midwives can personally prescribe a Schedule 4 (S4) medicine and/or administer a S8 medicine in accordance with their authority.
Any medicine supplied must be appropriately packaged and fully labelled according to regulation, and nurse practitioners must obtain prior written authorisation from the Department of Health before issuing any S8 medications – in addition to keeping an accurate clinical record of all medicines administered.
However, at the state level, the NSW Chief Nursing and Midwifery Officer (CNMO) authorised NPs back in 2020 to “possess, use, supply and/or prescribe any Schedule 2 and 3 medicine, restricted substance (Schedule 4) or drug of addiction (Schedule 8), where this is done in accordance with the NP’s scope of practice.”
This authorisation included all nurse practitioners working in NSW, in both the public and private sectors, and removed the need for privately practicing NPs to obtain written authorisation on an individual basis from the CNMO to possess, use, supply or prescribe S2, S3, S4 and S8 medications.
Similarly, QLD recently completed a consultation process on expanding nurse practitioners’ ability to prescribe with a proposal to amend Schedule 7, part 1 of the Medicines Regulation to enable nurse practitioners to prescribe unapproved medicines and administer a dose of unapproved medicines.
The next three-day PBAC meeting is planned for 6-8 November 2024, just five days after the changes come into effect. The public agenda is now available, and the opportunity for providing comments and input is open. The closing date for consumer comments is 25 September 2024.