Developing Nurse Practitioner models of care

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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.

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.

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 a 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 kind 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 a NP medication-assisted treatment of opioid dependence (MATOD) workforce.

We have worked collaboratively with a PHN and service providers to develop a NP Candidate business model for a regional community health service, which included a multi-year implementation plan. Using the business modelling, we were able to make recommendations that best met the health needs of young people in the region, as well as ensuring the financial viability of the NP model.

Larter has worked with several organisations to develop business and services models and implementation plans to help strengthen the NP workforce. Contact us if you’d like to talk about developing a NP model of care.

Further information is available in this article on the financial viability, benefits and challenges of employing a nurse practitioner in general practice.