Dr Haikerwal said the Government must provide a single MBS item number for all clinical tasks carried out by general practice nurses.

"The AMA has developed a formal policy on general practice nurses in an effort to maximise GPs' time with patients and to ease the impact of the medical workforce shortage on communities," Dr Haikerwal said.

"Australia's GPs are under enormous pressure wherever they are in practice - city or country.

"It is important that GPs get to spend more time with their patients who have chronic or complex illnesses or who present with serious injuries or emergency-type conditions.

"Many GPs are incorporating general practice nurses into their practice to perform certain supervised primary care duties and, in some cases, they will perform home visits or provide services to aged care facilities - under instruction and direction from the GP.

"We are now formally acknowledging the important contribution that general practice nurses can make to quality primary patient care in the general practice setting.

"The policy also stipulates that the GP must at all times be the leader of the primary care team.

"We are encouraging GPs to introduce general practice nurses to their practices and to utilise their skills in the best possible way to maximise patient care according to the local needs and conditions in their individual practices.

"The role of the nurse may vary from practice to practice but we want to ensure that the work is rewarding to the patients, the nurses, the GPs and the communities," Dr Haikerwal said.

Under the AMA policy, practices would define the role of the general practice nurse based on the specific needs of their local community. The clinical tasks of appropriately-trained general practice nurses could only be undertaken under the direction of the GP.

The policy was developed by the AMA Council of General Practice (AMACGP) and adopted by the AMA Federal Council at its Darwin meeting. A full copy of the policy is available on the AMA website at

AMA Policy Statement

General Practice Nurses

2005

Preamble

General Practice Nurses are defined as those nurses employed to work within a general practice setting as a member of a general practice team.

The AMA does not support the "independent nurse practitioner" as reflected in the variety of State/Territory legislated roles for nurses where levels of independence remove the general practitioner as central to delivery of primary care.

General Practice Nurses (GPN) make a valuable contribution to the profession of general practice and, while their role is complementary to that of the general practitioner, it is integral and adds value to the delivery of primary health care services in the general practice setting.

Within a practice, a positive and constructive relationship with general practitioners, based on mutual professional respect, establishes a GPN as an indispensable member of the health care and administration team.

Where practices employ GPNs there is an agreed responsibility to assist the practice to achieve best practice in patient care.

It is the role of the appropriate professional nursing bodies to develop and oversee education, training and continuing professional development of GPNs in consultation with general practice. In this context it is the role of the Royal Australian College of General Practitioners to work with the appropriate professional nursing body to represent general practice in the development of relevant curriculum.

The role of the GPN will vary according to the specific needs of the practice, the qualifications and specific skills of the GPN, and the needs of the local community that the practice serves.

The AMA is of the view, however, that the establishment of clear and agreed practice protocols, particularly those related to clinical care, must form the basis for the role of the GPN within the practice.

Special circumstances often give rise to a broader clinical role for some GPNs in some practices. Such situations serve to emphasise the vital importance of specific practice protocols in clearly outlining what a GPN within the practice may or may not do, most particularly in relation to clinical care.

In developing practice protocols the AMA suggests that these might be devised under four key headings:

• Clinical care
• Clinical organisation
• Practice administration (including practice systems and risk management processes)
• Integration (with other health providers)

The AMA is of the view that practice protocols that relate to the role of the GPN should be documented and developed in consultation with the practice's GPN.

Policy Resolution

General Practice Nurses are a valuable part of general practice and an integral member of the general practice team.

The role of the General Practice Nurse is complementary to that of the general practitioner and general practice services.

General Practice Nurses do not substitute for general practitioners.

The responsibility of the General Practice Nurse is to assist the practice to achieve best practice in patient care. It is thus essential that the role of the General Practice Nurse is clearly established within the practice.

General Practice Nurses must not work independently of general practitioners.

The development of specific practice protocols outlining the role of the General Practice Nurse must be developed in consultation with the General Practice Nurse. Such protocols should be documented and in particular outline clinical care roles and responsibilities of the General Practice Nurse, required skills and qualifications to undertake specific roles.

The role of each General Practice Nurse will vary according to the specific needs of the practice and the community it serves.

The clinical roles of the General Practice Nurse may only be undertaken under the direction of the general practitioner in accordance with agreed practice protocols and where the General Practice Nurse is appropriately skilled and trained to undertake specific tasks.

The role of the General Practice Nurse must not include:

• Formulating medical diagnosis
• Referring patients to specialists
• Independent ordering of pathology or radiology
• Prescribing medication and issuing repeat prescriptions