News
GP-led teams must be central to nurse practitioner plan: RACGP
It is ‘imperative’ nurse practitioners are embedded with a patient’s usual GP and practice as much as possible, the college says.
Nurse practitioners have a valuable role in primary care as part of a coordinated, GP-led practice team, the RACGP says.
The RACGP has raised concerns over a proposed model of care that could see nurse practitioners practice independently, suggesting that strategies to expand their scope of practice are being developed without broad consultation.
In a college submission to the Department of Health’s Nurse Practitioner 10 Year Plan (the Plan), which aims to address national nurse practitioner workforce issues and improved delivery of nursing care, the RACGP acknowledges the important role nurse practitioners play – but as a complementary service to GPs.
‘Nurse practitioners have a valuable role in primary care as part of a GP-led practice team, delivering integrated and coordinated care, either co-located or external to the general practice location such as residential and aged care facilities,’ the submission states.
While the college supports the Plan as a strong opportunity to establish an equitable, high-quality model of primary care that places general practice as the most accessed part of the healthcare system, it is concerned that offering care independent of a patient’s usual GP will result in fragmented care.
‘GPs remaining as the patients’ first point of contact within the healthcare system and retaining ultimate oversight of patient care allows for comprehensive assessment, diagnosis, initiation of treatment, and referral to appropriately qualified team members [including nurse practitioners] in accordance with their qualifications, areas of clinical expertise and levels of support,’ the submission states.
‘Losing this important opportunity for holistic, comprehensive and integrated care could prove detrimental to patients.’
Some of the potential risks identified by the RACGP include:
- duplication of patient services, eg consultations, pathology and diagnostic imaging due to care not being coordinated through general practice as the central point of care
- inappropriate and unnecessary referrals to other healthcare professionals/services, potentially resulting in increased wait times
- increased prescribing of medicines and doses, and possible polypharmacy compared to usual care prescribers
- decreased efficiency of resource allocation and increased flow-on costs throughout the healthcare system.
By outlining the scope of practice, consumer experience, workforce sustainability and collaborative arrangements, the college submission recommends the Plan focus on solutions and strategies that promote GP-led team-based models of care so as to facilitate:
- continuity of care between patients and their regular GP
- clinical roles, responsibilities and accountabilities within a GP-led general practice team within their defined scope of practice and according to each health professional’s level of education, training, supervision and clinical expertise
- genuine links to the patient’s general practice to reduce the risk of duplicated services, fragmented and low-value care and wasted valuable health resources.
According to the Plan’s consultation paper, Australia currently has 2251 nurse practitioners, approximately one-third of whom work in regional, rural and remote areas.
A total of 174 nurse practitioners were engaged by eligible general practices receiving incentive payments through the Government-incentivised Workforce Incentive Program Practice Stream in the August 2021 quarter, up from 148 in the May 2020 quarter.
The recent
MBS Review Taskforce report noted a broad range of different funding arrangements in current nurse practitioner operating models having a direct impact on the sustainability of such models of care, and the
RACGP supports the reform of funding for general practice and other primary healthcare services through the Primary Health Care 10 Year Plan, also considered in the development of the Nurse Practitioner 10 Year Plan.
Meanwhile, the college has raised concerns around the framing of the Plan’s
consultation paper and survey, which suggest that strategies to expand nurse practitioners’ scope of practice are already being developed without broad consultation.
‘Referral pathways and clinical handover requirements should be clearly defined as they are key to providing safe, efficient and high-benefit patient care,’ the submission states.
‘These arrangements, if developed in consultation with general practice and other stakeholders will be an important consideration in future planning of the role of nurse practitioners.
‘The RACGP would welcome additional time to undertake more meaningful consultation with its members on this topic … [and] requests involvement in future opportunities to comment on the Plan as it is developed, particularly regarding any specific strategies or recommendations.’
Log in below to join the conversation.
coordinated care GP-led team nurse practitioners primary care funding
newsGP weekly poll
What is your chief concern with role substitution?