Removal of collaborative arrangements will unleash Endorsed Midwives and Nurse Practitioners and benefit patients

The Australian College of Nursing (ACN) enthusiastically welcomes the Government’s introduction to Parliament of the Health Legislation (Removal of Requirement for a Collaborative Arrangement) Bill.

ACN CEO, Adjunct Professor Kylie Ward FACN, said passage of this Bill will allow endorsed midwives and nurse practitioners to use their training, education, and skills to work to their full scope of practice, practise autonomously, and deliver more care to patients.

“This is a win for nursing and a win for patients, especially those who live in rural, regional, and remote communities, and other underserved communities,” Adjunct Professor Ward said.

“The removal of collaborative arrangements will provide nurses and midwives with much-deserved respect and acknowledgement of their clinical expertise.

“The requirement to have a collaborative arrangement has limited the ability of many appropriately qualified Nurse Practitioners.

“The removal of collaborative arrangements will provide many patients and communities with better, quicker, and more affordable access to important care and treatments.

“We hope this landmark decision attracts more Registered Nurses to become Nurse Practitioners and more Midwives to become Endorsed.

“Primary health care Nurse Practitioners support diverse groups, including people in aged care, First Nations peoples, and people with disabilities.

“They are also often the most highly qualified – or the only – health professional in a lot of rural and remote communities.

“Endorsed midwives and Nurse Practitioners working in these settings have been establishing innovative health services.

“They will soon be able to practise autonomously. Patients will benefit,” Adjunct Professor Ward said.


A collaborative arrangement is an arrangement between an eligible midwife/eligible Nurse Practitioner (NP) with a medical practitioner that must provide for consultation with a specified medical practitioner; referral of a patient to a specified medical practitioner; and transfer of the patient’s care to a specified medical practitioner, as clinically relevant.

A collaborative arrangement, as described in terms of Nurse Practitioners, is an arrangement that limits a Nurse Practitioner’s scope of practice and imposes a restrictive level of oversight that is not required by any other health professional in Australia.

Collaborative arrangements have the effect of denying access to available and high-quality healthcare to people in remote and rural areas of Australia.

Since 2010, legislation has required NPs and eligible midwives across Australia to establish collaborative arrangements with doctors in order to practise in a range of settings including hospitals, primary care, and aged care.

NPs can meet the requirements in a variety of ways, including being employed by a service that has one or more doctors, having a written agreement with a doctor, or verbal acknowledgement of the arrangement.

Overarchingly, collaborative arrangements for nurse practitioners relate to whether a patient is entitled to a Medicare rebate on the cost of a nurse practitioner service, or a PBS subsidy on their prescription.

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