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Midwives continue to be encumbered with collaborative arrangements despite the Medicare Review process recommending their removal

8 April 2019

The Department of Health are currently consulting with the health workforce on the Medicare Benefits Schedule (MBS) Review Taskforce reports. The Participating Midwife Reference Group (PMRG) report is overall very clear and consistent with current evidence. It is generally supportive of midwives and midwifery practice and recommends the implementation of midwifery continuity of care, which ACM has been consistently lobbying for. ACM is however confused at the failure of the Report to recommend the abolition of the requirement for a collaborative agreement. Perplexingly, the same recommendation put forward by the Nurse Practitioners Reference Group has been allowed to remain, bringing into question the reasoning and potential influences behind this decision.

The history of the collaborative agreement goes back to the initial drafting of the National Law when the then Minister for Health the Hon. Nicola Roxon MP insisted that nurse practitioners and “eligible” midwives were to have the same requirements. At the time the ACM predicted this requirement would be an insurmountable barrier to women accessing Medicare rebateable midwifery services and indeed it was. After much lobbying the “Determination” was revised in 2013, enabling collaborative arrangements with health services or medical practitioners.

However, this was not enough as we still have states and territories where midwives are unable to develop collaborative arrangements or gain admitting rights. Endorsed midwives have been subject to unprecedented scrutiny since the National Law was proclaimed and the NMBA Safety and Quality framework was endorsed. Despite this the MBS Taskforce is still promoting the position that endorsed midwives require “oversight” by a medical practitioner.

The question must be asked how the PMRG, composed of midwifery experts, could not have recommended the removal of this requirement; and how the Taskforce could consider treating nurse practitioners differently to endorsed midwives, given the Government’s historic position. This glaring omission to the Report threatens to devalue the entire consultation process.

ACM, has written to Hon Greg Hunt MP and Professor Bruce Robinson, Medicare Review Taskforce on the 8th March to express our concerns at the omission of the recommendation to remove the mandated requirement for a collaborative agreement. To date ACM has received no response and the Report available on the website continues to omit this recommendation.

Midwives are competent, collaborative and safe practitioners. There is strong and consistent evidence to show that the current collaborative arrangement requirements not only restrict midwives ability to practice but hinder women’s ability to access a midwife of their choosing. Furthermore, current collaborative agreement requirements bar true collaboration. It is time for non-evidence based barriers to midwifery care to be abolished.

The ACM along with all members of National Nursing and Midwifery Education Advisory Network (NNMEAN) want midwives to have the opportunity to consult on the contentious collaborative arrangement requirements.

The Nurse Practitioners Recommendation around collaborative agreements can be found in section 5.4.1 Recommendation 8 – Remove the mandated requirement for NPs to form collaborative arrangements (documents available online:

Additional information

The Australian College of Midwives (ACM) is the peak professional body for midwives in Australia who are registered with, and regulated by, the Nursing and Midwifery Board of Australia (NMBA). The ACM’s position is that women be attended during pregnancy, birth and postnatally by a midwife who is registered with the NMBA.

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