BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE
As general practice contemplates a future that involves an ageing population, an increasing incidence of chronic disease, the drive for patient-centred care and different funding models to support new models of care, it is worthwhile contemplating what that future would look like without practice nurses.
According to the Health of the Nation 2019 Report, 92 per cent of GP respondents indicated their practice employed a practice nurse and the average number employed in a practice is 3.1. With about 14,000 nurses working in general practice across the country, they are an essential part of general practice as we know it in Australia.
They support GPs in providing a comprehensive range of services, yet in many instances are underutilised. Data from the Australian Primary Health Care Nurses Association (APNA) Workforce Survey 2018, indicates that of the nearly 50 per cent of primary healthcare nurses who suggested to their employer they could be undertaking more complex activities within their scope of practice, less than half were permitted to do so. Reasons cited for this by APNA’s President in a recent MJA InSight+ article include lack of support by the broad healthcare team, and financial and resourcing challenges.
Practice nurses have clearly contributed to the success of general practice as one of the most cost-effective and efficient sectors within the Australian healthcare system. Over the last 20 years there has been steady growth in the number of practices employing practice nurses. The Government has recognised the importance of the role and put in place financial arrangement to support practices in building their teams and expanding the services they provide. General practice nurses are involved in the delivery of comprehensive care including care coordination, patient education, immunisations, health assessments, supporting chronic disease management and the management of the clinical environment.
Satisfaction levels amongst primary care nurses are reported to be high, particularly regarding being a valued member of the team, working collaboratively and effectively within the team and contributing to patient satisfaction and positive health outcomes. However, nurses also commonly reported that lack of time and financial remuneration affected their ability to perform their roles. Twenty-five per cent reported they had never been offered a pay increase.
As valued members of the healthcare team, it is important that practice nurses have opportunity for career development, to work to their full scope of practice, and are appropriately remunerated for their contribution to general practice. Current financing arrangements make this difficult and this needs to be addressed as part of our advocacy for a strong, effective and viable general practice now and in the years ahead.
Worryingly, estimates suggest that with an ageing workforce and no clear career pathway, there will be a significant workforce shortage of full-time equivalent practice nurses by 2025.
It is good that the Government is focused on developing a new Primary Care Strategy and has announced some additional funding for general practice that is now starting to flow. However, if we want a high performing primary care model that delivers better access and outcomes for patients, we cannot allow this to be jeopardised by ignoring the future of our practice nurse workforce.
Improving employment opportunities, recruitment and retention of nurses in primary health care settings will be essential if our plans for the future of general practice are to be realised. To that end, I would encourage you to engage with your practice nurses on how their skills and experience could be put to better use. To look into what career supports are available through their professional organisation to help them upskill where required and to support them when transitioning into general practice.
The AMA has recognised this and is working hard to improve the level of financial support that is available to practices that employ or want to employ practice nurses. We are targeting the Workforce Incentive Program and calling for annual indexation as well as a lift in the cap on the level of subsidy that is available.
General practice has embraced team-based care and moving forward means that policy settings need to keep pace with change. The old approach of providing a subsidy and then letting it be steadily eroded is limiting how much more we can progress, and it is time that the Government move to address this and set up durable and sustainable funding arrangements for our practice nurse workforce.
Published: 13 Nov 2019