Additional Comments - Australian Greens

1.1The Australian Greens thank the organisations and individuals who made submissions to the Community Affairs Legislation Committee during this inquiry. We also thank the secretariat for their hard work during this inquiry.

Overview

1.2The Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025 (the bill) will allow people to get prescriptions from a qualified registered nurse (nurse prescriber) who is working to their full scope of practice. Nurses have been pushing this reform for a long time, and the Australian Greens welcome the long overdue decision.

1.3Nurses have historically been underutilised and underappreciated within the health system, and this bill goes some way towards recognising the role that they can play in managing quality patient care. With many people struggling to afford healthcare and dealing with waiting lists that are too long, this change will allow people faster and more affordable access to quality healthcare.

1.4Submissions to this inquiry by nurse representative organisations make it clear that this change will increase availability of healthcare services where there might otherwise be limited access. The Australian Primary Health Care Nurses Association (APNA) said in their submission:

Nurses play a critical role in providing essential health care access, managing complex and chronic health conditions and keeping people out of hospitals which is particularly necessary where there is limited or no access to a regular general practitioner.[1]

1.5Touching on a similar point, the Australian Nursing and Midwifery Federation said in their submission:

Expanding a registered nurse’s scope of practice to include nurse prescribing will enhance patient access to medicines particularly in rural and remote communities, vulnerable and marginalised populations, which often have high levels of trust in the nursing profession.[2]

Safeguarding

1.6Some submissions raised concerns around ensuring that nurse prescribing is implemented in a way that ensures the highest standard of patient safety.

1.7The Greens are deeply focused on ensuring that the safety and comfort of people is paramount when accessing healthcare, regardless of the type of practitioner they are accessing it from.

1.8As APNA have pointed out in their submission, nurses are very highly trusted by Australians to give safe, quality care and also are subject to fewer complaints, with only 0.5 per cent of nurses receiving a notification to NMBA/Ahpra in 2024/25, compared to 6.1 per cent of all medical practitioners in the same time period.[3]

1.9There are inclusions in this bill that specifically implement safeguarding boundaries, including:

The requirement for nurse prescribers to be in a prescribing agreement with existing prescribers, and to complete a six-month clinical mentorship with an authorised health practitioner,

Specific training and qualification requirements additional to those required to be a registered nurse,

The ability for the minister to designate particular medicines that can and can’t be prescribed by nurse prescribers,

The expansion of the Professional Services Review to ensure that nurses are subject to oversight in their role as Pharmaceutical Benefits Scheme (PBS) prescribers.

1.10The details of the implementation of this reform, including associated safeguarding measures, will be set out in delegated legislation and the Greens will carefully scrutinise that detail when it is made publicly available.

Podiatrist access to the PBS

1.11Through the course of this inquiry, there were over 20 submissions that identified an additional opportunity to expand the ability for health practitioners to prescribe medicines with attached PBS benefits.

1.12Podiatrists and podiatric surgeons are currently endorsed prescribers, meaning that they are fully qualified and permitted to prescribe medicines to patients. Despite this, they are not permitted to access PBS benefits for these prescriptions, meaning that their patients are paying full price for medicines that are otherwise subsidised by the PBS. The consequences of this situation are described by the Australian Podiatry Association in their submission:

...a podiatrist with an endorsement to prescribe medicines may clinically decide a medicine is needed today, yet the patient must still book a second consult just to obtain a PBS-subsidised script.[4]

1.13Advanced Practicing Podiatrists - High Risk Foot Group provided an example in their submission of what this looks like in practice:

A 72yo man on the aged pension, with a history of diabetes and related health problems attends a podiatry clinic near the end of the year for an annual review of his foot health, taking advantage of an Enhanced Primary Care referral from his GP. As part of the assessment, the podiatrist notes that while the circulation and sensation to the feet are within normal limits, there is a probable fungal infection in the toenails. The therapeutic guidelines recommend a 12-week course of oral terbinafine for the management of such conditions. As an endorsed podiatrist, it is within scope to initiate the prescription of oral terbinafine with an initial 6-week course of medicine.

The man has reached the PBS safety net of $277.20, so no longer is required to pay the $7.70 for his PBS medicines, but as the prescription provided by his podiatrist is a private script, not covered by the PBS, a discount pharmacy will charge $27.99 for a packet of 42 tablets. The patient is then in a dilemma. Why are they needing to pay for a script when they have reached the safety net? Why do they need to make an appointment with their GP (that may have an out of pocket cost) to receive the medicine subsidised?[5]

1.14This bill is an opportunity to correct this disparity and provide podiatrists and podiatric surgeons the ability to access PBS benefits when they prescribe medicines to their patients.

Conclusion

1.15The Australian Greens are supportive of measures that enable greater choice and accessibility for people seeking quality healthcare, including allowing registered nurses the opportunity to prescribe PBS medicines within their scope of practice.

1.16The Scope of Practice Review recommended this change, along with many other pathways to enable non-medical practitioners to play a greater role in provision of safe, quality healthcare. The Greens encourage the Labor Government to go further in their response to the Scope of Practice Review, and implement the identified opportunities for unlocking value within Australia’s healthcare system.

Senator Jordon Steele-John

Greens Senator for Western Australia

Footnotes

[1]Australian Primary Health Care Nurses Association, Submission 15.

[2]Australian Nursing and Midwifery Federation, Submission 42.

[3]Australian Primary Health Care Nurses Association, Submission 15.

[4]Australian Podiatry Association, Submission 7.

[5]APP-HRFG, Submission 6.