Nurses in general practice: entering a new era: nurses in general practice are fast becoming clinicians at the forefront of health care. Already recognised for their significant and positive impact on the quality, access and affordability of primary hearth care, their role is likely to grow as the federal government implements reforms to Australia's health care system.

• Jurisdiction: Australia
• Author: Anderson, Kathryn
• Date: 01 June 2012

Practice nurse manager Tanya Cross, who works out of a practice in Malvern Victoria, has seen many changes to her role over the 18 years she has worked in the sector. Ms Cross attributes these changes to the shifting health care needs of the community and the recognition of the skills that she brings to the practice. "When I first started it was very much like a reception role. I would answer the phone, take blood, do a couple of dressings and do a bit of filing. It was really like the doctor treated the patient and the nurse did odd jobs that the doctor told her to do."

Now she says she works collaboratively with the team. "They see me as a resource because I have the experience and knowledge. Often the GP will ask my advice about wound care for their patient or ask my opinion on vaccination. They still do the diagnosis but I can be there in a very supportive role for them."

Ms Cross is confident nurses in general practice will continue to evolve to meet the changing health needs of the community. With an ageing population and an increase in complex and chronic conditions amongst the community, the federal government recognises the need for better primary and community health services, as a way forward in keeping Australians healthy and easing the burden on the health system.

Government changes

The government hopes to encourage the expansion and enhancement of nurses in general practice role by introducing changes to the way nurses in general practice are funded. Introduced in January this year, the Practice Nurse Incentive Program (PNIP) has replaced a number of Medicare Benefits Schedule (MBS) practice nurse items with a single payment to acknowledge the many procedures nurses do that are not covered by item numbers.

[ILLUSTRATION OMITTED]

Australian Practice Nurses Association (APNA) Vice President Karen Booth says the PNIP is essential to supporting nurses in general practice through better recognising the contribution they make. Ms Booth says while MBS item numbers originally brought nurses into practices, the numbers fast became a constrainer to their role. "The PNIP funding model is not tied to a particular area of clinical work but allows general practice to employ nurses to work collaboratively within a multidisciplinary team in response to the needs of the community. The talents of the nurse in general practice should be used as part of the general practice team. Additionally, for many practices the only way to extend their services is to employ a practice nurse."

ANF Senior Federal Professional Officer Julianne Bryce says nurses already have a broad scope of practice, suggesting the PNIP will allow nurses to work to that scope of practice and allow for innovation to do a range of activities including health promotion and prevention. "The value of practice nurses has truly been established and we are seeing more emerging research that supports this. The old MBS nurse item numbers didn't really reflect the way nurses practice. It locked nurses into what they were able to do and hindered the way they could assist people along a pathway to better health through a range of promotion and prevention activities."

There are already pockets of innovation in prevention and promotion driven by nurses in general practice...