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The determination governing collaboration for private practice midwives has changed – It’s about time

Hands showing unity

ACM MEDIA RELEASE
August 13th 2012

The Australian College of Midwives congratulates the Australian Health Ministers on timely recommendations for private midwives.

“The Australian College of Midwives (ACM) congratulates the Australian Health Ministers on the excellent and timely recommendations coming out of the Standing Council on Health (SCoH) regarding privately practising midwives,” said Sue Kruske, President of the Australian College of Midwives.

Ministers recommended an extension of the professional indemnity insurance exemption for privately practising midwives until June 2015, enabling midwives providing homebirth services to have assurance that they would not be forced to abandon women or face prosecution for violating registration requirements. There has been no insurance available for birth at home since 2001 when HIH collapsed, and the current exemption was due to expire in June 2013. All efforts must now be made to access affordable insurance for midwives providing homebirth services before the new 2015 deadline.

At the SCoH meeting the Commonwealth also agreed to vary the Determination on collaborative arrangements to enable agreements between midwives and hospitals and health services. The ACM has been fighting for this outcome for two years. “In September 2010 the ACM met with the former Minister for Health’s office, Minister Roxon, asking for changes to be made to collaborative arrangements by removing the words with a ‘named medical practitioner’ and replacing them with a ‘health provider organisation.’ At the time this request was not heeded but ACM was given assurances that if medical professionals were reluctant to enter into arrangements then the Determination would be changed. The Federal Health Minister has recognised that the current arrangements are not working and been true to the undertaking given in 2010, one the AMA was fully aware of. Contrary to their claims the AMA was consulted about both these issues again at a recent roundtable organised by the Federal Health Minister in June of this year,” said President Kruske.

Midwives for the past two years, in good faith, have sought collaborative arrangements with obstetricians, with only a couple being successful in the entire country. Some midwives have written to every obstetrician in the State they live in seeking a collaborative arrangement, only to have either no response or negative responses.

“The vast majority of midwives practising today collaborate without the requirement to have a formal arrangement with a ‘named doctor’. The only time a collaborative arrangement is required under legislation is when women want to access Medicare rebates for private midwifery services. It is women who have suffered due to the current arrangements. There is misinformation being put out that this change is about homebirth. There are no Medicare rebates for birth at home so changing the Determination will have no impact on midwifery care for homebirth at all,” said President Kruske.

The largest randomised controlled trial in the world (2314 women), undertaken in Australia and published this month in BJOG, involved women receiving all their care from a primary ‘known midwife’ compared to women receiving standard fragmented care. The study showed much better outcomes under ‘known’ midwife led care, including a 22% reduction in the caesarean section rate. This is an example of the high degree of safety and quality that can come when midwives are able to collaborate with a whole health service and everyone in it.

“Midwives are committed to collaboration with all health service providers and this variation in the Determination will ensure this can now occur. It will not be a ‘hospital administrator’ midwives will be collaborating with, as claimed by the AMA, but an entire health service team, of which obstetricians are an important part. This is how the majority of health care is undertaken today and how 99% of midwives work. These changes will make sure 100% of midwives can now work in this optimal model of collaboration and hopefully open the doors of hospitals to private midwives through clinical privileging arrangements which to date have been slow,” said President Kruske.

Published 15th August 2012

Comments

2 comment(s) on this page. Add your own comment below.

Virginia Scott
Dec 4, 2012 2:06pm [ 1 ]

Jane have you any idea when these changes might come into play? I have been led to believe by Midwives Australia that as long as we have everything in writing to and from the women's hospital and family doctor and keeping strict records of this documentations that this is enough to prove a collaborative arrangement? Now I am planning on offering only private antenatal and postnatal care and education and I am very interested in the medicare aspect. I am an eligible midwife with a medicare provider number. I am very interested in the way things are going at present.

Dec 7, 2012 6:55am [ 2 ]

Hi Virginia - I don't have any idea as yet when the changes will occur. It could be ages yet (but it will happen). At this point the collaborative relationship is with an individual doctor so it has to comply with the details outline in the legislation (see below). Unless the collaborative relationship is with an approved doctor within a hospital - communication with the hospital doesn't come into play in regards to the collaborative relationship for Medicare purposes.

Here is the excerpt from the Medicare Schedule Book (December 2012):

M.13.5. COLLABORATIVE ARRANGEMENTS

To provide Medicare rebateable services an eligible midwife must have a collaborative arrangement in place that must provide for consultation, referral or transfer of care as clinical needs dictate, to ensure safe, high quality maternity care.

Under the legislation a collaborative arrangement can be with the following “specified” medical practitioners: 1) an obstetrician; 2) a medical practitioner who provides obstetric services; or 3) a medical practitioner employed or engaged by a hospital authority and authorised by the hospital authority to participate in a collaborative arrangement.

The types of practitioners listed 1) and 2) are defined in the Regulations as “obstetric specified medical practitioners”.

Collaborative arrangement can be established in the following ways: a) being employed or engaged by 1 or more obstetric specified medical practitioners or by an entity that employs or engages 1 or more obstetric specified medical practitioners; OR b) receiving patients by referral in writing to the midwife for midwifery treatment from a specified medical practitioner, OR c) having a signed written agreement with one or more specified medical practitioners, OR d) having an arrangement with and acknowledged by at least one specified medical practitioner a. an arrangement requires that the eligible midwife must record the following in the midwife’s written records: i. The name of at least one specified medical practitioner who is, or will be, collaborating with the midwife in the patient’s care (a named medical practitioner); ii. That the midwife has told the patient that the midwife will be providing midwifery services to the patient in collaboration with one or more specified medical practitioners; iii. Acknowledgement by a named medical practitioner that the practitioner will be collaborating in the patient’s care; iv. Plans for the circumstances in which the midwife will do any of the following: 1. consult with an obstetric specified medical practitioner; 2. refer the patient to a specified medical practitioner; 3. transfer the patient’s care to an obstetric specified medical practitioner. b. The midwife must also record the following in the midwife’s written records: 827 i. Any consultation or other communication between the midwife and an obstetric specified medical practitioner about the patient’s care; ii. Any referral of the patient by the midwife to a specified medical practitioner; iii. Any transfer by the midwife of the patient’s care to an obstetric specified medical practitioner; iv. When the midwife gives a copy of the hospital booking letter for the patient to a named medical practitioner – acknowledgement that the named medical practitioner has received the copy; v. When the midwife give a copy of the patient’s maternity care plan prepared by the midwife to a named medical practitioner – acknowledgement that the named medical practitioner has received the copy; vi. If the midwife requests diagnostic imaging or pathology services for the patient – when the midwife gives the results of the services to a named medical practitioner vii. That the midwife has given a discharge summary at the end of the midwife’s care for the patient to: 1. a named medical practitioner; and 2. the patient’s usual general practitioner

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