Mr   GAFFNEY   (Mersey)   -   Mr   President,   I   am   grateful   for   the   opportunity   today   to   speak   for   a   few   moments   on   the   vital   role   of   nurse   practitioners,   paramedic   practitioners   and   midwife   practitioners   in   communities   across   Australia   and   potentially   here   in   Tasmania.   I   would   not   be   surprised   if   I   am   currently   receiving   a   few   quizzical   glances   from   around   the   Chamber   at   this   point.   It   is   fair   to   say   that   until   I   had   the   privilege   of   meeting   with   both   the   national   and   state   representatives   of   the   Australian   College   of   Nurse   Practitioners   (ACNP)   during   the   consultation   for   the,   then,   End-of-Life   Choices   (Voluntary   Assisted   Dying)   Bill   I   was   not   well   acquainted   with   the   contribution   NPs   make   to   our   health   system.   Nor   was   I   aware   that   this   extended   career   path   was   possible   in   both   the   paramedic   and   midwifery   sectors.

Nurse   practitioners   who   have   a   bachelor's   degree,   registration   and   years   of   experience   complete   a   master's   degree,   specifically   preparing   and   upskilling   them   for   a   more   senior   and   independent   clinical   practice   role.   They   bring   a   wealth   of   experience,   knowledge   and   education   but   most   importantly   a   proven   commitment   to   their   local   community.   Currently,   there   are   only   35   to   40   NPs   in   Tasmania   with   only   half   to   two-thirds   of   those   working   in NP   roles due to a lack of funded positions.

In   the   private   setting,   NPs   work   to   their   full   scope   of   patient   care   including   full   assessment   workup,   ordering   X-ray   and   pathology   tests,   providing   patient   rebates   through   Medicare,   writing   prescriptions   and   access   to   pharmaceutical   benefit   scheme   medicines.   NPs also   refer   patients   to   hospitals   and   specialists   when   required.   The   paramedic   practitioner,   the   PP role, will offer a similar scope of practice.

In   the   public   system,   however,   NPs   attempt   to   work   to   full   scope.   They   run   clinics,   order   tests,   diagnosing   and   managing   care.   However,   currently   NPs   cannot   access   Medicare   as   they   are   not   entitled   to   have   a   provider   number   and   thus   cannot   bill   for   their   services.   The   issue   of   lack   of   access   to   Medicare   item   numbers   and   the   significantly   lower   rate   paid   to   NPs   for   their   consultations   by   the   Medicare   system   needs   to   be   addressed   with   our   federal   colleagues.   This   inequity   creates   financial   disincentives   to   both   practitioner   and   patient.   NP   roles   in   Australia   have   been   highly   scrutinised   and   have   resulted   in   a   proven   track   record   of   efficiency and safety since inception.

In   other   Australian   states   NPs   have   been   a   proven   mainstay   of   ED   departments   and   regional   areas   are   now   being   sought   for   primary   and   specialist   roles   including   GP   clinics, chronic   disease   management, respiratory   clinics,   cardiac   clinics   and   urgent   care   centres.    While   PPs   are   a   relatively   new   addition   to   the   health   workforce   in   Australia they   are   well   utilised   and   have   a   similarly   proven   track   record   in   the   United   Kingdom.   The   Australian   universities   have   realised   the   enormous   potential   and   are   currently   offering   accredited   master's   level   programs   to   create   experienced, educated   mobile   healthcare   providers   who   can   practice to an equivalent level of an NP.

It   is   a   fact   that   our   hospitals   that   cannot   contract   long-term   doctors   have   been   reliant   on   revolving   locums,   sometimes   for   only   two   or   three   days,   paying   for   interstate   flights,   cars   and accommodation   as   well   as   exorbitant   daily   rates   of   pay.   Emergency   departments   and   the   ambulance   service   bear   the   brunt   with   increasing   numbers   of   low   acuity   cases   presenting   and   clogging an already overburdened system.

In   the   north-west   of   the   state   it   sometimes   takes   up   to   two   to   three   weeks   to   get   an   appointment   with   your   own   GP   and   there   are   no   after-hours   GP   clinics   at   all   in   the   Mersey   locality,   I   believe,   with   just   one   clinic   open   to   7.30   p.m.   week   nights   in   Murchison.   The   costs of   an   NP   or   PP   salary   is   approximately   one-third   of   the   most   junior   locum.   It   has   been   suggested   that   utilising   the   skills   of   nurse   practitioners   would   be   a   more   cost-effective   use   of   finite resources.  

Most   significantly   for   our   communities,   NPs   and   PPs   take   permanent   contracts.   They   live   permanently   in   the   local   areas,   they   provide   stability   and   consistency   to   patients,   they   build   local   networks   and   understand   local   demographic   socioeconomic   and   population   health   issues.

An   immediate   and   plausible   support   for   our   overextended   health   system   would   entail   funding   for   options   such   as   an   urgent   care   centre,   UCC,   with   extended   opening   times,   close   to or   co-located   to   radiology,   pathology   services   or   a   hospital   that   is   multi-disciplinary   where   both   NPs   and   PPs   can   lead   the   clinic   and   outreach   as   required   by   GPs,   ambulance,   ED,   nursing homes et cetera to any location.

The   proposed   centre   could   also   serve   as   a   training   hub   for   NP   and   PP   candidates   to   build   our   workforce   and   attract   further   expertise   permanently   to   Tasmania.   Already,   PP   students   from   Victoria   are   signing   up   to   come   to   Tasmania   for   their   placements.   I   believe   there   is   a   huge   potential   for   NPs   and   PPs   to   be   part   of   a   long-term   sustainable   solution   to   some of the deficiencies in our health system, given the right support from the Government.

The   benefits   to   patients   for   these   models   of   care   include,   affordable   access   to   health   care;   increased   hours   of   access;   and   a   health   assessment   and   treatment   option   in   their   own   home.   An   example   might   be   a   palliative   care   client   who   has   a   concern   and   the   only   usual   option   is   transport   to   hospital   by   ambulance.   The   patient   could   be   treated   at   home   and   left   in   comfort   by   a   PP.   This   is   especially   important,   as   I   am   informed   that   there   are   no   palliative   care services on the north west coast after 5 p.m. weekdays or on weekends. M

s Forrest   - The college nurses do cover.

Mr GAFFNEY   - They do but not all the time.

Other   benefits   to   patients   include   continuity   of   care   with   the   patient's   own   GP   as   the   team   leader,   a   collaborative   and   multi-disciplinary   approach   across   health   fields,   reducing   the   exposure   risk   by   not   attending   hospitals   and   possible   testing,   vaccination,   health   assessment   on one site.

The   benefits   to   the   THS   and   employer   include   a   stable   workforce   with   career   progression   pathways   to   retain   our   best   staff, a   cheaper   but   efficient   and   a   safe   workforce.   It   reduces   ED   presentations   and   access   block.   It   reduces   ambulance   transports, keeping   ambulances   for   high   acuity   patients.   Tasmania   will   be   a   leader   in   innovative   solutions   for   health   delivery   and   will   benefit   from   the   draw   of   nurses   and   paramedics   to   the   roles.   It   is   a   cost-effective solution by upskilling an existing professional to do more in the community.

Modelling   has   already   been   conducted   by   the   THS   for   an   NP-led   centre,   the   Invermay   UCC   and   should   be   expanded   upon   for   inclusion   of   PPs.   I   encourage   the   Government   to   consider   and   move   forward   with   this   innovative   reasonable   and   affordable   solution   and   support   the   development   of   alternative   models   of   care   that   are   sustainable   and   safe   in   a   volatile health climate.

There   is   no   question   what   was   done   in   the   past   -   and   I   am   speaking   of   decisions   made   by successive governments over many years - is not working as effectively as it should be.

With   a   new   minister   and   extra   focus   on   health,   the   time   for   change   and   reform   is   here   with   practical   solutions   for   practitioner-based   care   to   provide   greater   access   for   patients   while at the same time easing the pressure on our hospitals and ambulance services.

Representatives   of   the   ACNP   and   ACPP   are   keen   to   meet   with   the   minister   and   interested   members   to   further   discuss   this   innovative   approach   to   improving   our   health   system and I would encourage members to speak with them.