The RACGP is pushing back against a proposal for the insertion or removal of long-acting reversible contraceptives (LARCs) and intrauterine devices (IUDs) by midwives to be covered by an MBS item.
The government has been taking steps to increase access to LARCs, providing training programs and increasing the associated MBS rebate for the insertion of them.
An MBS advisory committee looking into ways to increase access even further has proposed such MBS items should be expanded to procedures carried out by midwives.
But the RACGP has said GPs are still best placed to carry out these procedures.
In a written response to the committee’s draft report, College President Dr Michael Wright said: “Given the invasive nature of LARC procedures, MBS item access should remain limited to qualified practitioners.”
He said any future expansion of the item should be contingent on clear evidence of equivalent training, competency, and safety.
“Any practitioner performing these procedures must be held to the same standards of training, credentialling, indemnity and insurance as expected of other medical professionals,” his submission read.
“Although LARC insertion may appear to be a simple procedure to some patients and non-medical practitioners, the RACGP highlights that it involves inherent clinical risks and may present substantial procedural complexity in particular circumstances or patient population risk”
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Dr Wright acknowledged that women across Australia need better access to affordable and comprehensive care and said there was a need to expand access to comprehensive GP-led postpartum care.
He suggested funding be put towards strengthening multidisciplinary collaboration with endorsed midwives
“Appropriate and safe collaboration ensures safe, skilled insertion of postpartum LARCs, which remain underutilised across Australia.”
Dr Wright said state and Commonwealth initiatives that establish alternative funded services “often place greater expense on the overall health system” and instead said appropriately funding GP services was a cost-effective way to better deliver care.
The advisory committee’s report recommended that only endorsed midwives who had completed at least 5000 hours of clinical practice and postgraduate study for scheduled medicines, would have access to the MBS item.
It also outlined that recommended access to the item was solely for the insertion and removal of LARC devices for the primary purpose of contraceptive care.
A submission dated February 2025 from the Australian College of Midwives said: “Many health services across Australia have recognised the important role that midwives play as trusted care providers of counselling and contraceptive prescribing/insertion of LARCS and have adapted to enable endorsed midwives to fulfil this professional scope within the hospital sector.”
“Having scope discrepancy between workforce in primary care settings and those employed in hospital does not represent value for the Australian public.”
Following consideration of all consultation responses, a final report on the matter will be compiled for Minister for Health and Aged Care Mark Butler.
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