With tenders for the new Primary Health Networks (PHNs) due to be called before too long, there is considerable speculation and uncertainty about how the new organisations will shape up.
Nurses must have a central role in these new primary healthcare teams, says Kathy Bell, CEO of the Australian Primary Health Care Nurses Association (APNA).
Picking the primary care team
Kathy Bell writes:
It sounds almost cliché but the key to keeping our population well, out of hospital and ensuring our capacity to pay for our health care into the future lies in our ability to provide quality health and aged care in the community.
The idea that prevention and primary health care are the critical component of any health system is repeatedly cited in every health policy forum, opinion piece and report into our healthcare.
Most informed commentators know that shifting the balance away from acute care to prevention and primary care is the single most important investment we need to make for our future well-being. Many countries around the world are now focusing reform of their health care on developing effective prevention and primary care services.
Despite the weight of evidence, we are yet to realise that goal in Australia.
Australian health policy makers at both a State and Federal level tend to have a short sighted view of healthcare that values acute care at the cost of investment in the primary healthcare sector. We are told it is what wins votes – hospital beds remain the main focus of healthcare debates and political interest.
We are now at a crossroads in primary healthcare in Australia. The disbanding of the 61 Medicare Locals and introduction of the new commissioning model, Primary Health Networks (PHNs), presents both a risk of further entrenching our lack of focus on this important area of healthcare – and an opportunity to invest in and strengthen our primary healthcare response.
Recent changes in primary healthcare have centred on the need to reorient the system towards multidisciplinary care teams – extending beyond general practice and not relying solely on doctors as the providers of care.
While this is a sensible reform in developing a better mix of primary care services, the rhetoric has not been matched by the practice. Medicare Locals were widely criticised by doctors for not addressing their needs. Allied health providers report variable experiences with the level of engagement, and only limited improvement in accessibility to local services.
Nurses are the largest component of the health workforce in Australia, and a key and growing component of the primary health care workforce. Nurses are highly respected by the community as practical providers of primary care. Despite their numbers (11,000 in general practices in Australia alone), their standing and their skills, nurses remain a very underutilised sector of the primary care workforce.
Primary healthcare nurses have a long history of practical engagement in the provision of community based care. They provide preventive health interventions, chronic disease management and co-ordination, management of long term conditions, general care for the sick and care for our older population.
This community-based practical patient centred care is exactly what primary care should be. It is what we know keeps people well and out of hospital.
If we are to realise the full potential of our primary healthcare system in Australia, it is essential that we invest more in community-based primary care. Part of this investment must be in expanding access to quality community-based nursing care.
Warning over workforce shortages
There is growing concern that this goal will not be realised. Australia will face a shortage of 110,000 nurses by 2025 (HWA: 2013). We know we have an ageing nursing workforce in general practice – four in five are over 40, most are actually in their fifties (AMLA: 2012).
These alarming statistics sound a warning bell that we need to do more now to attract, develop and support as well as retain our primary care nursing workforce.
The Australian Primary Health Care Nurses Association (APNA) is pleased that Australian Government supported pathways to strengthen our primary healthcare nursing workforce through its funding of the Nursing in General Practice Program in 2014-15.
The program will help with recruitment and retention of a well- equipped nursing workforce, by driving the development of a general practice nursing framework mapped to education and training, professional standards, and scope of practice.
It is a step in the right direction, but there are still barriers to overcome if we are to improve primary care in Australia.
It is time we better encouraged and rewarded continuity of care, quality of care and achieving cost effective health outcomes. When we do, the care provided by nurses will be more highly valued.
We also need to achieve the full scope of practice of primary care nurses to ensure their skills and experience can be fully drawn upon in providing cost effective, quality care that meets consumer needs.
A thriving general practice nursing workforce can improve access to primary health care, and deliver that care in a better, more timely and cost-effective way, helping to contain the growing costs of general practice.
Primary care is the main game in health reform.
When it comes time for the proposed new Primary Health Networks to pick their teams and set their priorities, I am confident most will recognise the need to include primary care nurses in the planning and delivery of community based care.
Only those not concerned about achieving real health outcomes would sideline one of the most critical team players.
• Kathy Bell is CEO of the Australian Primary Health Care Nurses Association