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Nurses are fast becoming an integral part of Australian general practice, with more than half of all practices now employing at least one nurse.

It is a long way from a decade ago, when the former AGPN took up the challenge of increasing practice nurse numbers across the country — despite opposition from some GPs concerned about continuity of care.

Over the years, the dust has settled. Most concern has been alleviated by nurses proving they have an important role to play in general practice and the delivery of primary healthcare in Australia.

Australian Practice Nurses Australia (APNA) estimates there are now about 9000 nurses working in general practice, with about 60% of practices employing at least one nurse.

APNA says general practice nursing is the fastest-growing area in the healthcare sector and covers many areas of nursing practice including lifestyle education, aged care, mental health, maternal and child health, and wound management.

Dr Arn Sprogis is chair of the Australian Medicare Locals Alliance (AMLA) and has one nurse at his Hunter Valley practice. He says he introduced the role to his clinic about six years ago to address a desperate workforce shortage and hasn’t looked back since.

“It made some economic sense and it certainly made workforce sense,” he says. “It was the best thing we ever did. We now couldn’t live without our nurse.”

Dr Sprogis’ nurse plays a significant role in the practice, particularly with young patients (helping with immunisations and kids’ health checks) and the elderly (assisting with wound care and chronic disease management, in particular).

She also triages during busy periods at the clinic, assisting with minor traumas, assessing wounds and ensuring the practice runs smoothly.

“The triaging helps me run on time,” Dr Sprogis explains.

Areas where there are significant workforce shortages are particularly suited to having a practice nurse, but regional and city GPs could also adapt the nurse position to suit their needs, he suggests.

“You can’t talk about general practice now without talking about practice nurses in the same breath,” he says.

Money matters
The financial incentives for nurses have undergone some significant changes in the past year.

On 1 January this year, the Practice Nurse Incentive Program (PNIP) took effect in Australia.

In a nutshell, the PNIP initiative is designed to consolidate the funding arrangements of its predecessor, the Practice Incentive Program Practice Nurse Incentive.
The change saw six of the MBS items scrapped in favour of a single payment to eligible general practices (see box).

Dr Sprogis says it is important to look at nurses as more than a staff member doing fee-for-service activities in the practice. There are many other ways their presence saves money, he says, such as triaging and providing services that free up the GP. Often these savings are difficult to quantify.

“It is not a money thing, it’s a team thing,” he says. “Yes, if there was no money, we would have to think twice, but our patients would miss out.”

Increasing role
Jan Chaffey is executive officer of the Camp Hill Medical Centre in Queensland and a former national president of the Australian Association of Practice Managers.

As the head of a busy practice on the outskirts of Brisbane that sees some 1400 patients a week, she says there is plenty to do for the 17 doctors, 13 administration staff, 10 nurses and various other allied health professionals who call the practice home.

“Our nurses are always focused on the best care for patients and that will always be given whether there is an item number or not,” she says.

“In our sort of environment, we’re very much a team. The nurses do the nursing and the doctors do the doctoring, and they work together.”

Ms Chaffey says more and more practices are moving towards larger operations and these mergers present opportunities for nurses to play a larger role in a practice.

Her centre has come a long way since it took on its first practice nurse in 2000. Today the 10 nurses have specialised roles within the practice.

Their duties include diabetes education, clinical support for procedures such as wound dressings and immunisation, as well as mental health and community nursing, where they visit patients in their homes for health assessments.

She says most practices have nurses who multi-task across these areas, but at her practice at Camp Hill, they tend to specialise in one area.

Practice managers also play a major role in co-ordinating the nursing team, and information is regularly shared with the GPs and other allied health professionals on site.

“This works for us and it really frees the doctors up a lot,” Ms Chaffey says, although she acknowledges that a program of this scale would be difficult to replicate in all practices.

But she is adamant that the philosophy of allowing nurses to specialise — particularly according to their area of skill — is adaptable to even a practice with a nurse on staff for just one day each week.

“You have to be willing to change the way you do things, but it is well worth it — both for the practice and the patients,” she says.

Care and management
Rhian Parker, senior research fellow at the Australian Primary Health Care Research Institute, has comprehensively studied the value of nurses in primary healthcare settings. She says they can be invaluable in general practice.

“There is very good evidence internationally that well-trained nurses are very good at managing patients with chronic conditions,” she says.

She says research suggests patients look to a GP for diagnosis and treatment, and to the nurse for care and management. “I think nurses are very good at co-ordinating care and they usually have a lot of knowledge across the board,” she says.

But while this is a burgeoning industry, Ms Parker warns there could be some problems on the horizon.

Future workforce
An ageing practice nurse workforce is a major issue, with the bulk of practice nurses now aged between 50 and 59.

Younger nurses are more inclined to seek the financial rewards of hospital work as the shift penalties and other incentives often make it more lucrative than general practice.

“Nurses do get tired of shiftwork though, and the challenge that we’ve got is how we attract younger nurses to make a career in general practice,” Ms Parker says.

In the meantime, she strongly advises GPs and practice managers to do their homework when considering taking on a practice nurse. It is vital to consider the needs and demographics of the practice’s patient base and match the skills of the nurse accordingly.

It is also imperative to have a plan so that the nurse can be utilised for the maximum benefit.

“Really, the time of the nurse should be maximised to release doctors to do other things,” she suggests. “I can’t see the point of having a well-trained registered nurse to clean the fridge.”

AMLA’s nursing in general practice team’s national principal advisor Lynne Walker says the alliance is committed to supporting doctors to include nurses on their team. She sees big changes in the way nurses are utilised in general practice.

“I believe there will be more practice nurses becoming nurse practitioners in the years to come — it’s the pinnacle of clinical care in the primary care base,” she says.

Ms Walker agrees it is important to get the fit right when taking on a nurse.

“The needs of a rural practice will be very different to the needs of a regional practice,” she says. “It is important to think very clearly about what you want to achieve with the nurse, and what skills will be needed.”

It is also important to consider the needs of the nurse.

“Nurses will not get good job satisfaction if they are not able to use the skills they’ve got and that could lead to high staff turnover,” she says.