““I would like to respectfully acknowledge I would like to respectfully acknowledge the Traditional the Traditional Custodians of the land on which we meet Custodians of the land on which we meet today and Elders both past andtoday and Elders both past andpresent.”present.”

Collaborative Arrangements Collaborative Arrangements between an Eligible Midwife and between an Eligible Midwife and

medical doctor [s] in a QH medical doctor [s] in a QH maternity facility: maternity facility:

for the implementation of national maternity reform for the implementation of national maternity reform measures – Increasing women's access to measures – Increasing women's access to

Medicare and PBS rebates for private midwifery Medicare and PBS rebates for private midwifery

carecare

Improving Maternity Services in Australia - Improving Maternity Services in Australia - The report of the Maternity Services The report of the Maternity Services

Review, 2009. Australian Government: Review, 2009. Australian Government: Department of Health and Aging Department of Health and Aging

National maternity services reformNational maternity services reform

Commonwealth legislation has been Commonwealth legislation has been enacted to enable nurse practitioners and enacted to enable nurse practitioners and eligible midwives to access the national eligible midwives to access the national health care scheme. health care scheme.

The following points summarise the changes to legislation The following points summarise the changes to legislation that has occurred, that impact on Queensland Health and that has occurred, that impact on Queensland Health and

its employees. its employees.

National Registration Authority Scheme - NRAS

Australian Health Practitioners Registration Authority - AHPRA

Nurses and Midwives Board Australia - NMBA

Australian Nursing and Midwifery Accreditation Council - ANMAC

National Registration and accreditation for Chiropractic, Dental, medicine, Nursing and Midwifery, Optometry, Osteopathy, Pharmacy, Physiotherapy, Podiatry, Psychology and from 2012; Aboriginal and Torres Strait Islander Health Practice, Chinese

medicine and Medical radiation Practice. Mandatory reporting of registrants Demonstration of continuing practice development

and recency of practice National boards with the power to delegate all board

decisions Criminal history and identity checks Simplified complaints arrangements for the public Student registration Handling of complaints

Amended/ enabled Acts to enable access:Amended/ enabled Acts to enable access: The Health Legislation Amendment The Health Legislation Amendment

(Midwives and Nurse Practitioners) Bill 2009(Midwives and Nurse Practitioners) Bill 2009 Health Insurance Act 1973 for MBS accessHealth Insurance Act 1973 for MBS access National Health Act 1953 for PBS accessNational Health Act 1953 for PBS access National Health (Pharmaceutical Benefits) National Health (Pharmaceutical Benefits)

Regulations 1960 Regulations 1960 Health Insurance (midwife and nurse Health Insurance (midwife and nurse

practitioner) Determination 2010practitioner) Determination 2010 Queensland Legislation - Health (Drugs and Queensland Legislation - Health (Drugs and

Poisons) Regulation 1996.Poisons) Regulation 1996. Collaborative arrangements for MBS/PBS:Collaborative arrangements for MBS/PBS: National Health (Collaborative arrangements National Health (Collaborative arrangements

for nurse practitioners) Determination 2010.for nurse practitioners) Determination 2010. National Health (Collaborative arrangements National Health (Collaborative arrangements

for eligible midwives) Determination 2010.for eligible midwives) Determination 2010.

INDEMNITY INSURANCE:INDEMNITY INSURANCE:

Under the National Registration and Accreditation Under the National Registration and Accreditation Scheme (NRAS) for health professionals that came into Scheme (NRAS) for health professionals that came into effect from 1 July 2010, midwives will be required to effect from 1 July 2010, midwives will be required to carry professional indemnity insurancecarry professional indemnity insurance

Midwives employed will be covered by their employers’ Midwives employed will be covered by their employers’ insurance arrangements. insurance arrangements.

Private practice or self employed midwives had no Private practice or self employed midwives had no access to Indemnity Insurance access to Indemnity Insurance

MIGA insurance won the tender and developed a MIGA insurance won the tender and developed a package with Commonwealth supported run off cover. package with Commonwealth supported run off cover.

Professional indemnity cover does not cover to claims Professional indemnity cover does not cover to claims relating to homebirths. relating to homebirths.

Continuing professional development (CPD)Recency of practiceProfessional Indemnity Insurance (PII)Criminal historyEnglish language skills

ELIGIBILITY:ELIGIBILITY:

The only requirement for midwives The only requirement for midwives applying for a Medicare provider number applying for a Medicare provider number is to be an “eligible midwife”. This is is to be an “eligible midwife”. This is achieved by a notation on a midwife’s achieved by a notation on a midwife’s registration by the Australian Health registration by the Australian Health Practitioners Registration Authority Practitioners Registration Authority (AHPRA). (AHPRA).

In summary, the midwife must demonstrate the In summary, the midwife must demonstrate the following to achieve eligibility status:following to achieve eligibility status:

Current general registration as a midwife in Australia Current general registration as a midwife in Australia with no restrictions on practice;with no restrictions on practice;

Midwifery experience - equivalent of 3 years full time Midwifery experience - equivalent of 3 years full time post initial registration as a midwife;post initial registration as a midwife;

Current competence;Current competence;

Successful completion of an approved profession Successful completion of an approved profession practice review programpractice review program

20 addition hours per year of continuing professional 20 addition hours per year of continuing professional development development

Formal undertaking …’an accredited and approved Formal undertaking …’an accredited and approved program of study determined by the Board to develop program of study determined by the Board to develop midwives’ knowledge and skills in prescribing’midwives’ knowledge and skills in prescribing’

COLLABORATIVE COLLABORATIVE ARRANGEMENTS:ARRANGEMENTS:

A key issue with access to MBS/PBS is the A key issue with access to MBS/PBS is the legislated requirement for legislated requirement for written collaborative written collaborative arrangements with a medical doctorarrangements with a medical doctor

Midwives do not need a “collaborative Midwives do not need a “collaborative arrangement” to become eligible. This is a arrangement” to become eligible. This is a requirement of the MBS/PBS items.requirement of the MBS/PBS items.

Medical doctors do not have to have a Medical doctors do not have to have a collaborative agreement or enter into one with collaborative agreement or enter into one with an Eligible midwifean Eligible midwife

What is a collaborative What is a collaborative arrangement?arrangement?

A collaborative arrangement is an arrangement between A collaborative arrangement is an arrangement between an eligible midwife/eligible nurse practitioner with a an eligible midwife/eligible nurse practitioner with a medical practitioner that must provide for:medical practitioner that must provide for:

consultation with a specified medical practitioner;consultation with a specified medical practitioner; referral of a patient to a specified medical practitioner; referral of a patient to a specified medical practitioner;

and and transfer of the patient’s care to a specified medical transfer of the patient’s care to a specified medical

practitioner,practitioner, as clinically relevant, to ensure safe, high quality health as clinically relevant, to ensure safe, high quality health

care.care.

Collaborative arrangement can be Collaborative arrangement can be demonstrated by:demonstrated by:

being employed or engaged by a medical being employed or engaged by a medical practitioner or an entity that provides practitioner or an entity that provides medical services; medical services; OROR

receiving patients on written referral from receiving patients on written referral from a medical practitioner; a medical practitioner; OROR

a signed written agreement with a a signed written agreement with a specified medical practitioner/s; specified medical practitioner/s; OROR

an arrangement in the midwife’s or nurse an arrangement in the midwife’s or nurse practitioner’s written records.practitioner’s written records.

Written collaborative arrangements are Written collaborative arrangements are required by MIGA not Mediprotect. If this required by MIGA not Mediprotect. If this is unattainable, a submission of a care is unattainable, a submission of a care plan to a public hospital, and plan to a public hospital, and acknowledgement by public hospital, will acknowledgement by public hospital, will meet MIGA requirements. meet MIGA requirements.

For the definition of authorised midwife in For the definition of authorised midwife in subsection 84 (1) of the Act, the following subsection 84 (1) of the Act, the following

kinds of medical practitioners are specified:kinds of medical practitioners are specified:

an obstetrician:an obstetrician: a medical practitioner who provides a medical practitioner who provides

obstetric services;obstetric services; a medical practitioner employed or a medical practitioner employed or

engaged by a hospital authority and engaged by a hospital authority and authorised by the hospital authority to authorised by the hospital authority to participate in a collaborative arrangement.participate in a collaborative arrangement.

MisconceptionsSupervisory roleLegally responsible for the actions of the midwifeSupport homebirthExtra workExtra on callRealityProfessionalismCollegialityHealthy women and babiesTimely and appropriate access to medical careEffective and timely use of resources

Queensland Health is committed to enabling the Queensland Health is committed to enabling the Commonwealth reform.Commonwealth reform.

There are over 85 eligible midwives in There are over 85 eligible midwives in Queensland. Queensland.

Queensland Health hospitals have not had Queensland Health hospitals have not had formal arrangements with self-employed formal arrangements with self-employed midwives. However, there have been informal midwives. However, there have been informal arrangements in some facilities whereby the arrangements in some facilities whereby the public maternity hospitals have information public maternity hospitals have information relating to the care of a women choosing private relating to the care of a women choosing private midwife care. midwife care.

Why bother?Why bother?Women!!!!Women!!!!

Women are aware of the national Women are aware of the national maternity reform and there maternity reform and there has been an increase of has been an increase of women seeking private women seeking private practice midwifery care with practice midwifery care with a preference to birth in a a preference to birth in a hospital. hospital.

Safe and equitable access to careSafe and equitable access to care

EPPM role in Queensland is a EPPM role in Queensland is a service innovation and service innovation and integral to the health integral to the health workforce reform agenda in workforce reform agenda in Australia. Australia.

The statewide working group was The statewide working group was developed through the Nursing and developed through the Nursing and Midwifery Office Queensland. Midwifery Office Queensland.

The first stage was to pilot collaborative The first stage was to pilot collaborative arrangements at Toowoomba Hospital. arrangements at Toowoomba Hospital.

Toowoomba hospital was chosen as Toowoomba hospital was chosen as they had executive and medical support they had executive and medical support for collaborative arrangements.for collaborative arrangements.

A private practice midwifery group, in A private practice midwifery group, in Toowoomba were willing to be involved Toowoomba were willing to be involved in pilot project. in pilot project.

The successful pilot of collaborative The successful pilot of collaborative arrangements and roll out of three more arrangements and roll out of three more makes Queensland the first state in makes Queensland the first state in Australia to successfully implement the Australia to successfully implement the National Maternity reforms working for National Maternity reforms working for the benefit of women.the benefit of women.

Project outcomes to date have Project outcomes to date have included included

Mapping the Patient JourneyMapping the Patient Journey Establishing a credentialing and scope of clinical Establishing a credentialing and scope of clinical

practice process at the local levelpractice process at the local level Formalization of a collaborative agreement between Formalization of a collaborative agreement between

the obstetricians of Toowoomba Hospital and Five the obstetricians of Toowoomba Hospital and Five (5) Private Practice Midwives(5) Private Practice Midwives

Development of a License agreement to between Development of a License agreement to between the District Chief Executive officer and Eligible the District Chief Executive officer and Eligible Midwives with a signed collaborative agreement, at Midwives with a signed collaborative agreement, at Toowoomba Hospital.Toowoomba Hospital.

Statewide Collaborative Statewide Collaborative Arrangements Steering CommitteeArrangements Steering Committee

to oversee the Statewide roll outto oversee the Statewide roll out to advise on, and determine Statewide to advise on, and determine Statewide

processes and templatesprocesses and templates to provide high level key stakeholder to provide high level key stakeholder

engagement with Districts regarding the engagement with Districts regarding the Statewide development of processes and Statewide development of processes and templates for the roll out of collaborative templates for the roll out of collaborative arrangementsarrangements

Roll out of further sitesRoll out of further sites

IpswichIpswich Gold CoastGold Coast BundabergBundaberg

Employment as a midwife

Public Private Self employed Hybrids of all of the above

Eligibility Medicare 19(2) exemption – revenue for public employed midwives to attract

Medicare rebates

 

Into the futureInto the future

For Queensland to find pathways: For Queensland to find pathways: to ensure national reform measures are to ensure national reform measures are

implemented successfully; implemented successfully; for women to have equitable and safe for women to have equitable and safe

access to midwifery care and; access to midwifery care and; for women to have timely and safe access for women to have timely and safe access

to medical services.to medical services.

To identify, develop and implement collaborative To identify, develop and implement collaborative arrangements by identifying and articulating:arrangements by identifying and articulating:

Agreed pathways for consultation, referral and Agreed pathways for consultation, referral and transfer of a woman and/or babytransfer of a woman and/or baby

Credentialing processCredentialing process model to enable admitting rights for PPMmodel to enable admitting rights for PPM Public employee relationship pathways to be Public employee relationship pathways to be

exploredexplored Clinical Handover as per the Australian College Clinical Handover as per the Australian College

of Midwives consultation and referral guidelines. of Midwives consultation and referral guidelines.

To facilitate collaborative partnership and enable To facilitate collaborative partnership and enable ongoing sustainability EPPM Model of care. ongoing sustainability EPPM Model of care.

Strategic national framework to guide policy and programme development across

Australia over the next five yearsFocus is Primary Services not specialist

services

Woman centeredEvidence based

Continuity of care Culturally competent

“Closing the gap”

Thankyou Thankyou