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LCQ2: Introducing a registered nurse practitioners system
     Following is a question by the Hon Edward Leung and a reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (February 8):


     It is learnt that the United States, in facing a manpower shortage of doctors, has introduced a nurse practitioners system under which nurses may become nurse practitioners after completing studies of relevant programmes, so that they may use their nursing expertise and experience to share part of the workload of doctors. Some states even allow nurse practitioners to provide consultation independently. In this connection, will the Government inform this Council:

(1) whether it has studied the introduction of a registered nurse practitioners system in Hong Kong and the offer of programmes related to nurse practitioners in universities;

(2) as it is learnt that at present the Hospital Authority has established nurse clinics for some specialties, whereby nurses conduct follow-up assessments of the conditions of patients referred by doctors and monitor patients' medication, whether it knows the implementation details and effectiveness of such work; and

(3) given that there is a serious shortage of healthcare manpower in Hong Kong, and the demand for healthcare manpower will become more acute due to an ageing population, whether the Government will consider introducing a registered nurse practitioners system, so as to strengthen district healthcare services and support the implementation of the Primary Healthcare Blueprint?



     Thank you the question and suggestion raised by the Hon Edward Leung. This topic reflects the concern about the manpower shortage in healthcare services. I would like to explain the Government's strategy in healthcare manpower planning and professional development. 

     Starting from 2012, the Government has set up a Steering Committee (Steering Committee on Strategic Review on Healthcare Manpower Planning and Professional Development) to review the healthcare manpower planning and professional development strategy, to study the healthcare manpower planning and regulation in Hong Kong. In 2017, the Steering Committee published a Strategic Review (Strategic Review on Healthcare Manpower Planning and Professional Development), which pointed out the role played by nurses in advanced nursing practice and enhanced quality of care in clinical specialties.

     Currently, doctors and nurses perform different functions in the healthcare system, they are indispensable and have respective strengths and division of work, just like black and white keys on a piano. The Government's policy has all along been sparing no effort in strengthening the role of nurses in care services so that they could provide better care for patients with their professional expertise. Examples include: 

(1) As mentioned by Hon Edward Leung, the Hospital Authority (HA) launched the Integrated Model of Specialist Out-patient Services through Nurse Clinics (Pilot Scheme) in 2018/19. Patients in the pilot scheme will be followed up by nurse clinics at different stages of their treatment, apart from consultations with doctors. Nurse clinics under the pilot scheme are managed by Advanced Practice Nurses and nurses who have received specialist training. They directly engage in taking care of patients, including preliminary physical examination of patients prior to consultations with doctors, as well as investigation, assessment, nursing care. The pilot scheme covered 24 nurse clinics and four specialties upon its launch in 2018/19, and has been expanded to 115 nurse clinics and 17 specialties in 2022/23; and

(2) Nurses also play a very significant role in the area of primary healthcare services. In District Health Centres (DHCs), nurses are "care coordinators" who conduct health risk assessments for DHC members; work with other allied health professionals to develop personalised and humanised health management plans for citizens and provide healthcare advice with a multi-disciplinary collaborative approach; and arrange for those in need to be further diagnosed by network medical practitioners. Our Primary Healthcare Office will continue to collaborate with the Hong Kong Academy of Nursing to offer the Post-registration Certificate Course in Primary Health Care Nursing (DHC Module) so as to enhance the skills of nurses in primary healthcare and encourage them to give full play to their potential in the development of primary healthcare in Hong Kong.

     On the other hand, in tandem with the strengthening role taken up by nurses in provision of healthcare services, the Government has also implemented various measures to enhance their professionalism, thereby further raising the standard of our healthcare services. For example: 

(1) the Government has invited the Nursing Council of Hong Kong (NCHK) to launch the Voluntary Scheme on Advanced and Specialised Nursing Practice in co-operation with the Hong Kong Academy of Nursing in 2018, under which core competencies were formulated for all the 16 specialties with a view to enhancing the professional competence of nurses and the service quality of clinical specialties in Hong Kong. Both the DH and the HA will organise training courses for eligible nurses to encourage them to qualify as specialised nurses;

(2) On the other hand, the HA created the new rank of Associate Nurse Consultant in 2021/22, on top of the pre-existing rank of Nurse Consultant, and has continued to recruit more staff for the Nurse Consultant and Associate Nurse Consultant posts. This has enhanced the career progression pathway of the nursing grade and showcased the quality of nursing care and the mode of service delivery; and 

(3) HA launched the "Greater Bay Area Specialty Nursing Knowledge-exchange Programme" in 2022, under which nurses in the Mainland are arranged conduct professional exchanges with HA nurses in Hong Kong in order to raise the quality of nursing care.

     To maintain the level of service of Hong Kong's healthcare system, apart from enhancing the professionalism of nurses, we also need to retain and attract nursing talents. In fact, in addition to the shortage of doctor manpower in Hong Kong, our nursing manpower shortage situation is also very serious. When implementing the new concept of nurse practitioners system, we need to consider that deploying experienced nurses to undergo training for an extended period so that they could perform duties of doctors may in fact further affect the supply of nursing manpower for provision of nursing care. The Government is in fact actively retaining and attracting nursing talents. Other than maintaining the Specialty Nurse Allowance, the Home Loan Interest Subsidy Scheme and the Extending Employment Beyond Retirement policy at the HA, the NCHK has increased frequency of its Licensing Examination for Part I (General) Registration from once to twice a year since 2016.

     The Government has also announced in the 2022 Policy Address its plan to create new pathways for admission of qualified non-locally trained nurses by way of legislation, including introduction of limited registration and special registration regimes, with reference to experience gained from amending the Medical Registration Ordinance in 2021 for admission of non-locally trained doctors. Moreover, to ensure the professional standards of nurses and tie in with measures in the 2021 Policy Address, we will also require, by legislation, nurses' compliance with the Continuing Nursing Education requirement upon renewal of their practising certificates. We are consulting relevant stakeholders on specific details of the relevant proposals. Subject to the progress of deliberations, we plan to submit to the Legislative Council our proposed amendments to the Nurses Registration Ordinance (Cap. 164) in the first half of this year.

     All the aforementioned measures can serve the purposes of increasing the supply of nursing manpower, enhancing the training and professional standards. Under these circumstances, we considered that there is no need to establish another category of nursing professional qualification. As such, the Government has no plan to study the introduction of a nurse practitioners system at this juncture. Thank you, President. 
Ends/Wednesday, February 8, 2023
Issued at HKT 19:00
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