Discussion paper
Expanding the role of practice nurses in Australia
Eamon Merrick
Doctoral Candidate, Centre for Health Services Management, Faculty of Nursing, Midwifery, and Health, University of Technology, Sydney NSW; Director, Nursing Education, National Guard Health Affairs, King Abdulaziz Hospital
Kingdom of Saudi Arabia
Christine Duffield
Assoc. Dean Research, Centre for Health Services Management, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney NSW
Richard Baldwin
Senior Lecturer, Centre for Health Services Management, Faculty of Nursing, Midwifery, and Health, University of Technology, Sydney NSW
Margaret Fry
Higher Research Degree Program Coordinator, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney NSW
Helen Stasa
Research Officer, Centre for Health Services Management, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Sydney NSW
PP: 133 - 140
Abstract
Like other countries, Australia is looking to reforms in the primary health care sector to meet the growing demand for care. Expansion of the role of Practice Nurses (PNs) is one way in which this demand may be met. To date the Federal Australian government has played a significant role in encouraging growth in the PN workforce. If PNs tend to be GP directed, with little autonomy, care must be taken to consider whether to expand existing scopes of practice. In contrast, if PNs rely on their own independent clinical judgment and skill, this would support potential expansions to the scope of the PN role. Understanding these issues is important to inform the development of future workforce policy. This paper examines the structural policy dimensions within which these changes are occurring, and makes recommendations for future research on PNs.
Keywords
health policy; practice nurses; primary care; work preferences
Article Text
In Australia, as well as internationally, there is growing acceptance that we cannot continue to provide health care services in the same manner as we have. Rapidly rising health care costs, increasing demand for services, increasing prevalence of chronic and complex conditions, and workforce shortages in most health disciplines are some of the challenges facing governments today. There is an international recognition that primary health care offers strategic and cost-effective opportunities to address systemic health system challenges (World Health Organisation 2008; Prime Minister's Commission on the Future of Nursing and Midwifery in England 2010). Further impetus for the increased focus on primary health care provision comes from the fact that the patient groups being managed by health care providers are changing. In a pattern that is typical of many countries, health care service providers in Australia are treating a greater number of older patients (Britt, Miller, Charles, Henderson, et al 2009) and patients with a broader range of chronic health care issues. For example, in 2010, it was reported that 57% of patients had one reason for attending a general practice, 30% had two reasons, and 13% had three reasons. Additionally, in 2011 it was estimated that chronic conditions accounted for 36% of general practice activity (Britt, Miller, Charles, Henderson, et al 2011).
Background
One of the major changes proposed to meet this growing demand for health care services is an increased focus on the provision of primary care, which functions as ‘a hub from which patients are guided through the health system' and which ‘facilitates ongoing relationships between patients and clinicians' (World Health Organisation 2008, p. xvii). In Australia, governments at both the State and Federal level are developing and implementing policies which will impact on primary care service delivery (Agvall, Borguist, Foldevi, and Dahlstrom 2005; Australian Medical Workforce Advisory Committee 2005; Australian Bureau of Statistics 2006). These policies address what Kringos and co-workers (2010) refer to as the structural dimensions of primary care: governance, economic conditions, and workforce development. For example, the Federal Government has proposed strategies aimed at decreasing reliance on hospital care and dealing more effectively with chronic disease in the primary health care sector (Roxon 2008; Australian Government 2010a), including a $436 million funding boost to improve co-ordination of diabetes management and reduce diabetes-related hospital admissions (Diabetes Australia-NSW 2010). Further impetus for a relocation of services and resources to the primary care sector resulted from the National Health and Hospitals Reform Commission Report (2009), the Australian Government's response (Australian Government 2010b), and the Department of Health and Ageing's 2010 primary health care strategy ‘Building a 21st Century Primary Health Care System'. In line with the goals set out in the primary health care strategy the Federal Government has committed to investment in health professional education and training, reexamining and streamlining funding mechanisms, and to establish 36 General Practitioner (GP) Super Clinics (Australian Government Department of Health and Ageing 2010a). The re-examination of primary health care funding includes increasing and targeting funding for the provision of multi-disciplinary care arrangements for people with chronic illness. The Super Clinics will provide general medical practice services, along with procedural and specialists' rooms to provide child health, chronic disease, mental health, sexual health, dental, and Aboriginal Health services (Roxon 2010a). An aim of the Super Clinics is to create multidisciplinary community and primary health care teams, and to therefore shift service provision away from hospitals (Australian Government Department of Health and Ageing 2010a,b). It is expected by co-locating GPs, PNs, and other health professionals, the Super Clinic initiative will achieve efficiencies of scale, enhance access to primary care services, build primary care capacity, and reduce the utilization of tertiary care services. It has also been argued that the Super Clinic will provide a catalyst for the development of new ways of delivering services, or models of care (Australian Government Department of Health and Ageing, 2010b).
There are also Australian state-based initiatives that aim to expand the provision of primary health care. For example, NSW Health has been progressively implementing a program called HealthOne, spending more than AU$52million in 2010/11 to integrate primary and community health, again creating co-located multidisciplinary teams (NSW Department of Health 2010). Similarly, the South Australian government implemented the GP Plus program which resulted in several multidisciplinary clinics providing primary care in outer suburban locations (South Australia Department of Health 2009). These programs, along with initiatives in other states and territories, identify the direction of Australian health policy towards greater prevention, risk management and treatment in primary care settings (Phillips, Pearce, Dwan, Hall, et al 2008).
Workforce supply and organisation in primary care
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