Medicare review risks locking out nurse practitioners, at odds with Government's own workforce plan

The Australian College of Nursing

• The Australian College of Nursing (ACN) has warned that a major review of Medicare's primary care consultation items risks excluding nurse practitioners (NPs), despite proposing bulk-billing incentives for NP consultations for the first time.
• The proposed bulk-billing incentives would only apply to patients registered through MyMedicare, yet NP-led practices without a GP are currently ineligible to join the scheme, creating an inequitable barrier for NP and nurse-led practices.
• ACN argues that failing to incorporate NPs into Medicare's funding framework contradicts the Government's own Nurse Practitioner Workforce Plan, which commits to growing the NP workforce and removing barriers to practice.
• The review proposes lifting rebates for medical practitioners to at least match NP rebates but suggests no increase for patients seeing NPs, which ACN warns would widen the existing rebate gap; the organisation is calling for NP rebates to be aligned with GP rebates where the same service is provided within scope.
• The number of nurse practitioners in Australia has grown more than fivefold since 2012, with around 30 per cent working in regional, rural and remote areas, yet outdated regulatory and Medicare barriers continue to prevent NPs from establishing practices and delivering care, including in aged care settings.

Recommendations from a major review of Medicare’s primary care consultation items risk locking out nurse practitioners – one of the most valuable and fastest-growing parts of Australia’s health workforce, the Australian College of Nursing (ACN) has warned.

ACN welcomes the Medicare Benefits Schedule Review Advisory Committee report draft proposal to extend Medicare bulk-billing incentives to nurse practitioner consultations for the first time.

But the incentive would apply only where the patient is registered through MyMedicare with the practice, and NP-led practices without a GP cannot currently join MyMedicare.

“The Committee’s working group noted that NP-led practices’ current ineligibility for MyMedicare was out of scope for this review,” said ACN Chief Executive Officer Adjunct Professor Kathryn Zeitz FACN. “We are calling for the final report to recommend the Government undertake a review of the MyMedicare framework and accreditation requirements that addresses the inequitable exclusion of NP- and nurse-led practices.”

ACN says there is no evidence for the review’s remark that MyMedicare registration ensures patient safety and continuity of care, when accredited nurse practitioner practices already meet stringent National Safety and Quality Primary and Community Healthcare Standards.

“Nurse practitioners and nurses are independent primary healthcare providers who improve consumer access to safe, affordable and timely primary healthcare services,” said Adjunct Professor Zeitz. “If we do not better incorporate them into the primary healthcare funding architecture, we fail to future-proof the healthcare system.”

The draft also proposes applying the MyMedicare condition to new Medicare loadings for home visits and aged care visits.

“Too often, residential aged care facilities struggle to get a doctor to visit, particularly outside the cities,” said Adjunct Professor Zeitz. “Aged care nurse practitioners can help close that gap, but these rules would make it harder for them to do so.”

The number of nurse practitioners has grown more than fivefold, from 590 in 2012 to 3,194 in 2024/25 – yet outdated barriers mean they are continually excluded from opportunities to deliver holistic, high-quality care to Australians. One in seven NPs were not working in an NP role as of last year.

Failing to better incorporate nurse practitioners into Medicare is out of step with the Government’s own Nurse Practitioner Workforce Plan, which commits to growing the NP workforce and removing the barriers that hold it back.

“We know funding, regulatory and Medicare barriers are stopping NPs from establishing practices,” said Adjunct Professor Zeitz. “This review process is a key opportunity to address that.”

The review recommends lifting rebates for prescribed medical practitioners to at least match NP rebates but proposes no increase for patients who see NPs. ACN warns that boosting rebates for longer GP consultations without doing the same for NPs would widen the rebate gap and do nothing to meet the workforce plan’s goal of reducing out-of-pocket costs for NP patients.

ACN is calling for NP rebates to be aligned with GP rebates where the same service is provided within scope, and for NPs to be considered across every recommendation rather than item by item. It welcomes the review’s inclusion of NPs in the proposed after-hours loading as a step in the right direction.

Nurse practitioners are some of the most senior clinical nurses in Australia. Each is an experienced registered nurse who has completed a master’s degree and the equivalent of three years’ full-time advanced clinical practice and is endorsed by the Nursing and Midwifery Board of Australia.

NPs can assess and diagnose patients, prescribe medicines, order and interpret tests, and refer patients to other health professionals. They work in general practices, aged care homes, emergency departments, community health and rural clinics. Around 30 per cent work in regional, rural and remote Australia.

ACN’s submission is available on request.

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