professional Primary care

Rhian Parker workforce in Australia Lynne Walker Kelsey Hegarty A vision for the future

clearly defined professional roles, is underpinned Keywords: general practice; health policy; practice nursing; nursing, by quality assured education, and supported education by a career framework. Such policy needs to have a clearly articulated vision about what the profession of primary care nursing should look like in 2020 so that it can support the health and wellbeing of an aging population and integrate into the new reform agenda. The National Health and Reform Commission Report (NHHRC)1 Future roles for the practice and the Draft National Primary Health nurse Care Strategy2 offer a vision for a A Royal Australian College of General better coordinated, multidisciplinary Practitioners and Royal College of Nursing primary system in Australia. Australia evaluation predicted that in future, Equitable access, improved care and care practice nurses (PNs) will undertake a greater coordination in primary health care are integration role with more time spent in clinical core components of this vision. Integral care and clinical organisation, and less time on to this is a workforce that can work in an practice administration.3 Policy development in interprofessional way to provide quality the United Kingdom over the past decade has and timely care to patients. There is good resulted in enhanced roles for practice nurses. evidence supporting nurses undertaking Here, nurses were given extended roles in an expanded role in the primary health response to general practitioner shortages, an care team.2–4 increased workload for the primary care sector, the development of the primary health care Over the past decade, the role of nurses in general team and a reorientation of care to prevention, practice has increased and, in 2007, there were health promotion and the management of 7824 nurses employed in Australian general chronic disease.4 These roles included the practice.5 Strategies to support and extend these management of chronic conditions such as roles via Medical Benefits Scheme (MBS) and the asthma, diabetes, hypertension and epilepsy Australian Government’s practice nurse incentive and enhanced roles in health promotion and in 2001 have included: screening and other preventive health checks.4 • funding targeted item numbers to enable Significantly, practice nurses in the UK were nurses to fulfil limited roles also shown to be effective in triaging requests • funding to general practice networks for home visits and successfully dealing with (‘divisions’) to provide informal support telephone consultations.4 Given this evidence, • continuing professional development activities it may be practicable for Australian PNs to • scholarships for a range of courses through the extend their roles in a similar way, thus taking Australian Practice Nurses Association.5 pressure off time poor GPs, particularly in However, policy development has thus far failed areas where GPs are in short supply. Australian to take a systematic and integrated approach nurses are positive about their role expansion to building a sustainable workforce that has to date5 and with adequate space and team

Reprinted from Australian Family Physician Vol. 39, No. 3, march 2010 159 professional Primary care nursing workforce in Australia – a vision for the future support could develop their role further.5 Primary Conclusion national primary health care strategy: a discussion paper from the Australian Government. Canberra: care nurses are known to achieve good patient Practice nurses can contribute significantly to Commonwealth of Australia, 2009. compliance and to communicate well with Australian general practice and the wider primary 3. Watts I, Foley E, Hutchinson R, Pascoe T, Whitecross L, Snowdon T. General practice nursing in Australia. 6 patients and it would make good sense for care sector as they respond to the Australian The Royal Australian College of General Practitioners them to work more consistently with patients government’s reform agenda. The UK experience and Royal College of Nursing Australia. 4. Richards A, Carley J, Jenkins-Clarke S, Richards DA. with chronic conditions who require ongoing shows that nurses can, and do, undertake a range Skill mix between nurses and doctors working in support and monitoring of their conditions. of complex and extended roles. However, policy primary care-delegation or allocation. Int J Nurs Stud 2000;35:185–97. Nurses could also take a greater role in development in this area needs to be more robust. 5. Senior E. How general practice nurses view their preventive activities, including screening. While To support these extended roles: expanding role. Aust J Adv Nurs 2008;26:8–15. they have been remunerated through the MBS • funding mechanisms need to be changed to 6. Keleher H, Parker R, Abdulwadud O, Francis K. The effectiveness of primary and community care nursing schedule for undertaking cervical screening, this reward complex tasks rather than focusing on in primary care settings. A systematic literature remuneration is still low and barriers exist to narrow MBS item numbers review. Int J Nurs Pract 2009;15:16–24. 7. Mills J, Fitzgerald M. The changing role of practice 7 nurses undertaking this work. The Australian • quality assured education for existing nurses in Australia: an action research study. Aust J government, while adding MBS items for PNs, PNs, that does more than train for specific Adv Nurs 2008;26:16–20. 8. Bonawit V, Watson L. Nurses who work in general has so far failed to pay attention to how nurses tasks, needs to be made available through medical practices: a Victorian survey. Aust J Adv would manage these change of roles within their universities and other accredited institutions Nurs 1996;13:28–34. 7 9. Pascoe T, Hutchinson R, Foley E, Watts I, Whitecross practice. Thus, while the first wave of PNs’ and funding should be allocated for this LST. The education needs of nurses working in role expansion has established a base for future • existing undergraduate curricula need to be Australian general practices. Aust J Adv Nurs role development much more needs to be done reviewed and the focus on primary care and 2007;24:33–7. to develop policy and funding mechanisms that prevention strengthened so that young nurses support change management, quality assured are attracted to a career in primary care and standardised education for these nurses and • there needs to be a career pathway for these inter-professional practice. nurses so that primary care is an attractive The complex remuneration mechanisms that option for all nurses who want to develop their currently support nurses working in general career in this sector of the health industry. practice need to be reviewed to enable the The NHHRC has called for a multidisciplinary funding of nurses to undertake more extended approach to primary health care. Nurses can be roles in patient care and care coordination. at the core of these multidisciplinary teams and Nurses should be remunerated according to their provide excellent patient care if they are properly skill level and the complexity of the tasks they trained, properly remunerated and offered career undertake and not according to their ability to options. It is now up to policy developers to individually negotiate with their employer. provide a robust framework for the next phase in if we are to redesign and strengthen our the development of practice nursing in Australia. primary health care system, as has been Authors suggested by the National Health and Medical Rhian Parker BSc(Hons), MSc, MPET, PhD, is Research Council, and if nurses are to take Associate Professor, Australian Primary Health on extended roles, universities, nursing Care Research Institute, Australian National organisations and registration boards need University, Canberra, Australian Capital Territory. to review existing undergraduate curricula [email protected] and better prepare nurses for the new health Lynne Walker RN, is Practice Nurse Consultant, system. In particular, prevention and primary Department of General Practice, University of , Victoria health care should feature more prominently in Kelsey Hegarty MBBS, PhD, FRACGP, DRANZCOG, these curricula. Most importantly, appropriate is Associate Professor, Department of General and quality assured post registration training Practice, , Victoria. needs to be developed in universities to up skill the current primary care nursing workforce and Conflict of interest: none declared. government needs to support such initiatives References through appropriate funding. Finally, there needs 1. National Health and Hospital Reform Commission. A to be a clearly articulated career pathway, so as healthier future for all Australians: final report of the National Health and Hospital Reform Commission. to attract and retain the best and brightest nurses Canberra: Commonwealth of Australia, 2009. to primary care. 2. Department of Health and Ageing. Towards a

160 Reprinted from Australian Family Physician Vol. 39, No. 3, march 2010