Australians are living longer than ever. But these extra years of life come with higher rates of long-term and complex conditions and greater health care needs.
The government wants to improve Australians’ access to primary care services. These services would usually be delivered by a GP. But as part of this change, a new review is exploring how other health professionals could expand their current scope of work to meet growing needs.
Nurses make up more than 50% of the health workforce and have untapped and under-used skills that would ease the skills gap in our health system. Within this group, nurse practitioners have advanced training and the potential to deliver more services than they’re currently allowed – without the oversight of a GP.
How will access to primary care change?
One of the big changes is that from October 2023, some patients will be able to register with one GP or general practice under the MyMedicare scheme. Those who are registered will start to have access to extra funded services like longer telehealth appointments.
The first patients who will get access to these benefits are people with multiple health conditions and/or additional social needs. Having one doctor who knows them, and their history, can connect them more seamlessly with all of the different health professionals and services. This saves patients and carers time, money and effort.
For MyMedicare to work, Australia will need more health professionals with the right skills available in cities, regional towns and in rural and remote locations.
Currently, Australia is set to have a shortfall of 10,600 GPs by 2032. This represents a serious problem. While steps are being taken to grow the GP workforce, this takes time. And with a worldwide health workforce shortage, it will not be easy.
Australia will need to find other solutions. One option is to look to nurses to take on tasks for which they are suitably skilled but have historically been undertaken by doctors.
How nurses can help
In the United Kingdom, the United States, The Netherlands and Canada, advanced nursing – where nurses have postgraduate education and training to take on more specialised tasks and roles – has been relied on for years.
At the most advanced level of nursing, a nurse practitioner is a trained registered nurse who provides advanced nursing care either independently and autonomously, or with a doctor. Nurse practitioners can assess and diagnose health problems, order and interpret diagnostic tests, prescribe medicines, refer patients to other health professionals and even admit them to hospitals.
Nurse practitioners have been practising in Australia since 2000, starting in emergency care, with more than 1,400 practising in total in Australia by 2019. However, unlike other countries, Australian nurse practitioners must work in collaboration with a doctor. If they were to practise more independently, nurse practitioners could expand health-care access for thousands of Australians, including those living in rural and remote areas.
A recent NSW Health report presented a framework for specialised rural nurse practitioners that shows how care might be provided to focus on local community needs. For people living with a disability, or chronic and complex conditions, nurse practitioners can provide services in their communities, such as diagnosis, treatment plans, dialysis and make referrals to a specialist, including via telehealth. This could reduce the need for long-distance travel or a long wait time to access a GP.
Don’t we have a shortage of nurses?
But it’s not just about reducing burnout, stress and workloads. Nurses want career development, the opportunity to extend their scope of practice with advanced training, and for these complex care skills to be recognised and used.
Access to opportunities for career development and progression is a key driver of nurse retention.
Why haven’t nurse practitioners already solved the workforce crisis?
Nurse practitioners are registered nurses who have additional postgraduate education and clinical training in their speciality area.
Nurse practitioners are currently required to work in collaboration with a doctor to deliver care, which limits the extent to which they can resolve the workforce gaps we face. A nurse practitioner can prescribe medications, for example, but must do so with oversight via a sign-off from a doctor.
The federal government’s nurse practitioner workforce plan aims to remove barriers to patients accessing a nurse practitioner. The plan is looking at whether nurse practitioners should provide Medicare-funded services, create additional nurse-led care items and remove the requirement for them to collaborate with doctors in delivering care.
The federal government’s current proposals may therefore see nurse practitioners working completely independently, in a similar way to that overseas.
But despite evidence showing nurse practitioners provide safe health care, the proposal has been met with concern from some doctors that increased independence may risk patient safety and lead to more fragmented care. They also argue it would be unfair for patients who can’t see a doctor and who must see a nurse practitioner instead.
What should happen next?
Delivering better quality primary health care in Australia ultimately means we need to make better use of our health services and align it with our changing population needs.
To achieve this, we will need to grow our nurse practitioner workforce and use them more effectively. Enabling nurse practitioners to use all their skills independently might also help to stem the loss of nursing workforce.
But expanding the scope of any profession must be done in a way that improves collaboration, team-based working and patient-centred care. Health care is safest and most effective when health professionals work together – and with patients – to make decisions about care. So it’s important for the plan to include incentives that make collaboration more likely between nurse practitioners and doctors.
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