Primary Health Care Nursing: Where To Next?

[hr]The contribution nurses make in general practice and primary health care will be critical to ensuring our healthcare system can meet the growing needs of an ageing and ever sicker population into the future. Kathy Bell, CEO of Australian Primary Health Care Nurses Association (APNA) explains how an education and career framework will help ensure the profession’s sustainability[hr]
Everyone from governments to health professionals to consumers agree that we should aim to keep people as well as possible for as long as possible, and out of hospital and residential aged care. To achieve this, we need to get better at caring for people in the community. Nurses are the largest and best distributed health profession, and will increasingly be the key to the delivery of primary health care, in general practice and other community based settings.
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[link to="Kathy Bell"]Kathy Bell[/link]
[link to="References"]References[/link]
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There is significant potential for nurses to play a greater role in primary health care in Australia. Let’s focus for the moment on general practice. Starting from a low base 20 or more years ago, there are now around 11,000 nurses
working in general practice in Australia, and it’s one of the fastest growing workforces in the nation 1. The majority of general practices employ at least one practice nurse 2, which is a significant development from where we were in Australia just a couple of decades ago. Primary health care nurses, including those working in general practice, play a key role in the management of long-term conditions and in caring for the sick and ageing in our community. The care primary health care nurses most commonly provide – preventative health interventions, chronic disease management and coordination, and care for the elderly – is vital in keeping people well and out of hospital and aged care.
But there are significant barriers to realising the full potential of the primary health care nursing workforce. Most notably, we have no national workforce plan to ensure the future sustainability of the profession. The capacity of the nursing workforce going forward is not a given. The Health Workforce 2025 3 report predicts a major shortage of nurses in Australia by 2025, and identifies this as a critical risk. This shortage will undoubtedly impact on general practice and primary health care. Although the number of nurses working in general practice has risen steadily over recent years, many of these nurses are due to retire in the next ten years. Already, more than four in five nurses working in general practice are aged over 40, with the largest cohort being in their fifties 4.
[pullQuote]“The capacity of the nursing workforce going forward is not a given. The Health Workforce 2025 5 report predicts a major shortage of nurses in Australia by 2025, and identifies this as a critical risk. This shortage will undoubtedly impact on general practice and primary health care.” [/pullQuote]
There are established career pathways for nurses within the tertiary sector, where opportunities continue to open up for advanced nursing roles. However, there is no formal education and training pathway into general practice
nursing, and no framework for skills development and career progression for nurses working in general practice. There is also no systematic support framework for re-entry into the profession.
There is no nationally consistent and supported program for undergraduate nurse clinical placements in general practice, nor is there a consistent transition to practice framework for graduating nurses and nurses from other settings who enter general practice. And access to education and training specific to nursing in general practice is patchy, variable and inconsistent.
In the absence of appropriate education, training and transition programs, there are significant risks that the number of nurses needed with the appropriate skill sets will not be available to meet the needs of general practice in the near future.
We need better defined and supported pathways into and up through general practice nursing. This will help us attract young nurses to the profession and keep developing their skills and expertise over time, so they stay in the workforce and keep contributing more value.
APNA is advocating strongly for government and stakeholder support for the development of an education and career framework for nurses in general practice, as a precursor to parallel frameworks for other primary health care settings. What might such a framework look like, and what might it achieve?
The framework would, first of all, address the need for a consistent approach to undergraduate nurse education and training, to ensure graduating nurses are reasonably prepared to work in a range of settings, not only hospitals. In addition to appropriate curricula, all nursing students should have the opportunity to undertake well supported clinical placements in general practice and other primary health care settings.
The framework would then address transition to practice issues for nurses entering general practice. This would ensure that newly graduated nurses, and nurses moving from other clinical settings into general practice, are well supported through structured education, training and mentoring. This would enhance the flexibility and productivity of the nursing workforce, as nurses could more readily work where they are most needed. It would also ensure that general practices themselves have information and resources to enable them to transition nurses into their practice, whilst ensuring safety and quality for consumers. We know that many general practices are currently reluctant to take on first year nurses in the absence of such support structures.
Finally, the framework would clearly identify a series of levels of primary health care nursing, from entry level through to advanced practice.
[pullQuote]“APNA is advocating strongly for government and stakeholder support for the development of an education and career framework for nurses in general practice, as a precursor to parallel frameworks for other primary health care settings.”[/pullQuote]
Nursing in general practice currently lacks formal recognition of varying levels of skills and responsibility. The framework would address this by defining the skills required for each level, along with the underpinning education required, and pathways for development from one level to the next, demonstrating how to move across and upwards. At each level, the skills and expertise, and also the responsibility, accountability, and autonomy of the nurse would increase. This framework would support nurses and enable them to see primary health care nursing as a career choice, not “just a job”, which will help to build and retain a motivated and committed workforce. It will also help employers, including general practices, to define their workforce needs and understand what skills and knowledge they require in their nursing team. In addition to the education and career framework, the financing system for general practice needs serious attention. Fee-for-service payments to GPs, alongside limited block grants for general practice nurses, perversely reward general practices to maximise GP consultations and throughput, instead of rewarding quality team care. The financing system must be reformed to support and promote high quality, person-centred multidisciplinary team care, and ensure good access for all.
Finally, we need to address the cultural, institutional and legislative barriers which prevent primary health care nurses working across their full scope of practice. There has been strong opposition by some professional groups in Australia to the development of advanced nursing roles. Primary health care nursing roles and scope of practice in Australia are underdeveloped, and the ratio of primary health care nurses to primary care physicians is significantly lower, in Australia compared with a number of other comparable countries. We need to address the barriers that currently prevent the Australian primary health care nursing workforce from meeting its full potential, using a lens that focuses on what is best for the community, not what is best for a particular professional group.
The primary health care nursing profession in Australia has come a long way, but still has a long way to go if we are to get the best out of our workforce. Developing and utilising the full potential of this workforce will help ensure we can deliver high quality, accessible and affordable primary health care to our community into the future.
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[title from="Kathy Bell"]Kathy Bell[/title]
Ms Kathy Bell has been CEO of the Australian Primary Health Care Nurses Association (APNA) since September 2012.
APNA is the peak professional body for nurses working in primary health care including general practice. With more than 4000 members, APNA provides primary health care nurses with a voice, access to quality continuing professional development, educational resources, support and networking opportunities. APNA’s vision is for a healthy Australia through best practice primary health care nursing.
Kathy has worked in health policy and management in government and non-government settings for over 20 years, and has a strong background and interest in chronic disease, primary health care, rural and remote health, and Aboriginal and Torres Strait Islander health.[top]
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[title from="References"]References[/title]
1 Australian Institute of Health and Welfare (AIHW). Australia’s health 2008. Cat. no. AUS 99. Canberra: AIHW. Available at: http://www.aihw.gov.au/publications/index.cfm/title/10585 (Accessed 20 March 2013).
2 2012. “2012 General Practice Nurse National Survey Report”. Australian Medicare Local Alliance. Available from: http://amlalliance. com.au/__data/assets/ pdf_file/0003/46731/2012-General-Practice-Nurse-National-Survey-Report.pdf#National GPN Survey report [Accessed 20 March 2013].
3 2012. “Health Workforce 2025 – Doctors, Nurses and Midwives”. Health Workforce Australia. Available at:https://www.hwa.gov.au/our-work/health-workforce-planning/health-workforce-2025-doctors-nurses-and-midwives [Accessed 20 March 2013].
4 2012. “2012 General Practice Nurse National Survey Report”. Australian Medicare Local Alliance. Available from: http://amlalliance.com.au/__data/assets/pdf_file/0003/46731/2012-General-Practice-Nurse-National-Survey-Report.pdf#National GPN Survey report [Accessed 20 March 2013].
5 2012. “Health Workforce 2025 – Doctors, Nurses and Midwives”. Health Workforce Australia. Available at: https://www.hwa.gov.au/our-work/health-workforce-planning/health-workforce-2025-doctors-nurses-and-midwives [Accessed 20 March 2013].[top]