A Nurse Practitioner (NP) is a Registered Nurse educated at Master’s level with a clinical specialty, and endorsed by the Nurses and Midwives Board of Australia (NMBA) to provide patient care in an advanced and extended role. The profession began in the USA in the 1960s and the first NP was endorsed in Australia in 2000. There are now over 1,800 endorsed Australian NPs in settings ranging from emergency departments (30% of NPs) to general practices (8%). They also work in aged care, paediatrics, chronic illness care, mental health, alcohol and drug services, youth health, and many other fields. 70% work in the public sector, but a sizeable number also have their own business and some combine private and public work.
NPs can attract a very limited range of MBS rebates; to prescribe treatment and medications from a formulary, through the PBS; order diagnostic pathology and radiology investigations; and refer patients to other healthcare providers.
The potential benefits of strengthening the NP workforce include addressing workforce shortages; enhancing patient access to services; offering longer consultations; and decreasing hospital re-admissions through proactive specialist patient follow-up.
What Is a Nurse Practitioner Model of Care?
A nurse practitioner model of care defines how an NP’s advanced clinical skills are integrated into a healthcare service to meet specific patient and community needs. Depending on the setting, the model may include assessment, diagnosis, treatment, prescribing, referral, follow-up and coordination with other health professionals. Models of care in nursing can be designed around a particular population, clinical specialty or service gap. For Australian health services, developing the right model also requires consideration of workforce roles, referral pathways, funding, governance and how the NP complements existing primary and community care.
The pathway for a nurse to become a NP is long and usually needs the support of a major health service. Public funding and support varies considerably between states and territories, with Queensland having the highest number followed by New South Wales then Victoria.
We believe that governments need to strengthen efforts and invest in the NP workforce particularly in rural and remote Australia and in community health services, where GP recruitment and retention is presently very difficult. Scholarships, more supported pathway programs and increased MBS rebates could improve the viability of NP roles.
Examples of Nurse Practitioner Models of Care
Examples of nurse practitioner models of care can include primary care clinics, sexual and reproductive health services, chronic disease management, mental health, alcohol and other drug services, aged care, youth health and outreach programs. In Australia, nurse practitioner services can be structured within public health services, community health organisations, Aboriginal Community Controlled Health Organisations or private settings. The appropriate model depends on local population needs, workforce availability, clinical scope, service demand and financial sustainability. A well-designed model should clarify how the NP works alongside GPs, nurses, allied health professionals and other providers.
Many innovative nurses are developing their own service models incorporating public and private funding to co-create their own role with patients and health services.
Larter has worked with several organisations to help strengthen the NP workforce including developing models of care, analysing NP business models and delivering implementation plans. For example, we have worked with a regional PHN to develop a business model and a two-year implementation plan to recruit a NP into Aboriginal Community Controlled Health Organisations (ACCHO) to meet the health needs of local Aboriginal communities and address the shortage of GP services in the region.
We also worked with a regional community health service to develop an NP model for their sexual and reproductive health clinic that considered:
- health needs of the local community
- GP engagement to ensure complementary work practices
- financial viability, including MBS revenue modelling
- risk assessment
- service integration
- flexibility to accommodate varying and complex patient needs.
Sexual health NPs in Victoria implement different service models, with some NPs practising from an established site and others providing outreach services. Many sexual health NPs are not attracting MBS as a revenue source; they believe it is not possible to do so within a public health service, but this is not necessarily the case.
Some ACCHOs experiencing workforce shortages and difficulties accessing local medical support are interested in working with appropriately trained and culturally experienced NPs. These kinds of NP models can focus on Aboriginal health, alcohol and other drug (AOD) services, and incorporate pharmacotherapy, such as opioid replacement therapy, within the scope of practice.
Another innovative model is an NP medication-assisted treatment of opioid dependence (MATOD) workforce.
We have worked collaboratively with a PHN and service providers to develop an NP Candidate business model for a regional community health service, which included a multi-year implementation plan. Using the business modelling, we made recommendations that best met the health needs of young people in the region, while ensuring the financial viability of the NP model.
Nurse Practitioners and Primary Care
Nurse practitioners and primary care can work together through complementary models that expand access while maintaining appropriate clinical coordination. When developing an NP service, organisations need to consider the local population, scope of practice, referral arrangements, clinical governance, workforce requirements and financial viability. This is particularly relevant when establishing nurse practitioner clinics in Australia or introducing an NP role into an existing community or primary care service. Larter Consulting supports organisations in assessing these factors, developing business models, and creating practical implementation plans for sustainable NP services.
Larter has worked with several organisations to develop business and service models and implementation plans to help strengthen the NP workforce. Contact us if you’d like to talk about developing an NP model of care.
Conclusion
Nurse practitioner models of care can provide health services with a flexible way to respond to workforce shortages, service gaps and changing community needs. A successful model needs to go beyond defining the NP role by considering clinical scope, governance, referral pathways, collaboration with GPs and other providers, funding, workforce requirements and long-term financial viability.
Frequently Asked Questions
A nurse practitioner model of care describes how an NP’s advanced clinical skills, responsibilities and scope of practice are integrated into a healthcare service to meet the needs of a specific population or community.
Examples include primary care clinics, chronic disease management, sexual and reproductive health services, mental health, alcohol and other drug services, aged care, youth health and community-based outreach.
Nurse practitioners can complement existing primary care teams by providing assessment, treatment, prescribing, follow-up, health education and care coordination within their authorised scope of practice.
Important considerations include local health needs, scope of practice, clinical governance, workforce requirements, referral pathways, collaboration with other providers, funding arrangements and financial sustainability.
Yes. Nurse practitioners can work across community health and other healthcare settings, depending on their endorsement, clinical specialty, role and the requirements of the organisation.