Abstract
BackgroundAcross the globe the emphasis on roles and responsibilities of primary care teams is under scrutiny. This paper begins with a review of general practice financing in Australia, and how nurses are currently funded. We then examine the influence on funding structures on the role of the nurse. We set out three dilemmas for policy-makers in this area: lack of an evidence base for incentives, possible untoward impacts on interdisciplinary functioning, and the substitution/enhancement debate.MethodsThis three year, multimethod study undertook rapid appraisal of 25 general practices and year-long studies in seven practices where a change was introduced to the role of the nurse. Data collected included interviews with nurses (n = 36), doctors (n = 24), and managers (n = 22), structured observation of the practice nurse (51 hours of observation), and detailed case studies of the change process in the seven year-long studies.ResultsDespite specific fee-for-service funding being available, only 6% of nurse activities generated such a fee. Yet the influence of the funding was to focus nurse activity on areas that they perceived were peripheral to their roles within the practice.ConclusionsInterprofessional relationships and organisational climate in general practices are highly influential in terms of nursing role and the ability of practices to respond to and utilise funding mechanisms. These factors need to be considered, and the development of optimal teamwork supported in the design and implementation of further initiatives that financially support nursing in general practice.
Highlights
Across the globe the emphasis on roles and responsibilities of primary care teams is under scrutiny
This paper explores the impact of current funding mechanisms on the employment and work practices of nurses in general practice in Australia
Nurses undertake a range of activities in Australian general practice, not all of which are funded through current FFS payment systems
Summary
Across the globe the emphasis on roles and responsibilities of primary care teams is under scrutiny. This paper begins with a review of general practice financing in Australia, and how nurses are currently funded. While the numbers of general practitioners in Australia are falling, over the last five years there has been a minor boom in general practice nursing [1]. Between 2005 and 2007 practice nurse numbers increased from 4924 to 7824, with nearly 60% of general practices employing at least one nurse [2]. The increased movement of nurses into Australian general practice follows similar moves in the United Kingdom and New Zealand [3,4] where the benefits of adding nurses to the staffing configuration, ranging from improved patient satisfaction to potential cost savings, have been well described [5]
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