By Larter Consulting working with APNA
The value of primary care nursing.
Our work with 37 nurse clinics has shown primary care nurses are central to Improving Medicare access in rural, regional and remote Australia.
In thin markets, GP supply is constrained, communities are ageing, chronic disease burden is high and travel barriers are real.
Nurse-led models of care are not side projects. They are one of the most practical ways to expand access, strengthen prevention and support sustainable general practice.
Larter has partnered with APNA, PHNs and general practices to help co-design, implement and evaluate nurse-led models of care, including evaluating more than 37 APNA seed-funded nurse clinics supported through the Australian Government.
Across this work, the messages are clear. Nurse clinics can deliver major benefits for patients, communities and organisations, including general practices. The clinic can and will succeed when primary care nurses are trusted, authorised and supported to work to the top of their scope. This work really flourishes where there is a good team climate in the practice and where public funding supports particularly types of clinics.
What do we mean by a nurse clinic?
A nurse clinic is not a nurse being delegated more tasks. It is a planned, nurse-led model of care, usually embedded within general practice but also in other settings (corrections, schools, community health) where nurses lead service planning and delivery.
Clinics usually specialise in a particular area such as diabetes management, healthy ageing, cancer screening, perinatal support, women’s health and outreach to marginalised communities or occupational groups.
These models are team-based, and GP-inclusive. At their best, the clinics allow nurses to lead the parts of care they are uniquely well placed to deliver including education, prevention, assessment, coordination, navigation, follow-up and relationship-based support.
Nurses often hold the trust, continuity and practical knowledge needed to reach people who are otherwise missed by the system. They can turn a discussion into planned care. They can identify risk early. They can help people understand and manage chronic conditions. They can coordinate across GPs, allied health, pharmacists, community services and family supports. And they can make prevention real.
In thin markets, this is not marginal work. It is core primary care infrastructure.
Why nurse clinics matter in thin markets
The rural, regional and remote access challenge is often described as a “GP shortage” problem. That is true, but not the full story.
The deeper issue is that many communities are trying to meet growing need with models of care that still rely too heavily on episodic GP attendances. In thin markets, that approach is fragile. It leaves prevention underdone, health assessments and chronic disease reviews delayed, older people struggling to attend, and nurses underused.
Nurse-led clinics offer a different way of organising care. These models do not replace GPs. They support GPs to work where their input is most needed – diagnosis, prescribing, complex decision-making and clinical oversight.
What evaluating more than 37 nurse clinics has taught us
Larter has seen that nurse clinics succeed when there is clinical, operational, financial and governance design.
Strong clinical design requires a clear priority group, a defined pathway, agreed nursing scope, and an understanding of where GP input is required.
Best practice operational design includes protected nurse time, rooms, admin support, recalls, booking rules, documentation templates and handover routines.
To succeed financial design requires a clear view of how MBS items, WIP-PS, PIP QI, local programs, grants and other funding mechanisms support the model.
Finally, there needs to be governance design: delegation, escalation pathways, indemnity arrangements, data review, CQI and team-based accountability.
When these elements are designed together, nurse clinics move from promising ideas to reliable service models.
Success is fostered with GP and Practice Manager buy in, good measurement and continuous quality improvement.
Primary care nursing is not a support function; it is a model-of-care asset
One of the clearest lessons from this work is that nurse clinics are most successful when nursing leadership shapes the model of care.
The strongest clinics were where nurses identified unmet need, enhanced their skills (where necessary), designed practical workflows, built trust with patients, coordinated multidisciplinary input and followed up to keep people engaged.
Nurse-led models create time for clinicians to reflect on whether and how to deliver best practice care. They also enhance patient education, self-management support and preventive care. These can all be difficult areas to fully deliver in standard appointments.
It matters for GPs. Nurse clinics provide GPs with extra confidence that holistic care is being delivered.
It matters for practices. Planned nurse-led sessions can create enhanced reputation
and more reliable revenue.
And it matters for communities. In rural and regional settings, a nurse-led pathway may be the difference between care being available.
Case study 1: Turning diabetes education into planned, group-based care
In one regional practice, high type 2 diabetes burden was creating growing demand for education, follow-up and repeat GP appointments. Demand could not be met through one-to-one GP appointments and external diabetes educators.
The model shifted diabetes education into a structured nurse-led group program. A credentialled diabetes educator led group cycles, supported by GP oversight, allied health input, templates and planned reviews. Patients received education, monitoring
and self-management support in a format that also allowed peer learning and shared problem-solving.
The nurse led the education, engagement and follow-up. GPs remained available for medication review, care planning and complex clinical decisions.
What made the model work was not the group format alone. It was the combination of a clear pathway, protected sessions, established templates, GP support and strong practice leadership. The model created a more efficient way to deliver education and helped reduce avoidable repeat one-to-one appointments.
Group-based nurse-led care can improve access and engagement, but it needs the right infrastructure such as space, scheduling support, clinical governance, an authorising environment, and funding that recognises the value of planned team care.
Case study 2: Taking primary care to older people
In another regional setting, older people – including residential aged care facility (RACF) residents and people facing transport barriers – needed more proactive assessment, care planning and navigation. Many required support that could not be delivered effectively through standard in-practice appointments alone.
The practice developed a nurse-led healthy ageing pathway built around 75+ health assessments, home visits, RACF visits, structured recalls, My Aged Care navigation and GP review.
Nurses led assessment, education, safety checks, navigation and continuity. They helped patients and families understand what support was available and connected them with the broader care system. GPs remained central to clinical review, prescribing
and care planning.
The model had eight sessions per week, home and RACF visits, a full waitlist, and was profitable, with space constraints.
The model worked because it was embedded into the practice. It had a Practice Manager champion, nursing capacity, formal home-visit procedures, admin support, safety processes and indemnity arrangements. Demand was strong, with a waitlist demonstrating the value of taking primary care to people who may otherwise struggle to access it.
Outreach is not an optional extra. But safe and sustainable outreach requires funding for the non-billable work that makes it reliable: planning, travel, coordination, documentation, follow-up and governance.
What should happen next for nurse-led care
The next phase of nurse-led care should not be another round of isolated pilots. The evidence has been building for years and is strong enough to move to deliberate scale.
For PHNs, commissioners and peak bodies, this means commissioning the model, not just the activity.
A nurse clinic funding model should recognise the full pathway and opportunities available and fund the implementation supports that make the model safe and sustainable.
The APNA projects have shown there is a strong case for targeted micro-grants to foster nurse clinic starts. Small investments to fund clinical upskilling, room fit-out, equipment, group visit infrastructure, recall tools, data extraction and addressing nurse backfill can unlock barriers to clinics getting started.
Peak bodies have a very important role in making the value of primary care nursing visible. Nurse-led models should not be framed as a workaround for GP shortage. They should be framed as good primary care design: the right professional, working to the right scope, supported by the right funding and governance, in partnership with other clinicians.
A practical opportunity for Medicare reform
The national conversation about rural, regional and remote Medicare access and funding creates an opportunity to rethink what access means in thin markets.
If access is measured only as GP attendance, policy will miss one of the strongest available levers: enabling primary care nurses to lead structured, preventive and chronic care models within team-based general practice.
From pilots to primary care infrastructure
Larter Consulting’s work with APNA-funded nurse clinics shows that nurse-led care is one of the clearest and cleverest examples of what becomes possible when primary care nurses are supported to work to the top of their scope.
The next step is to commission nurses more broadly, to meet population health need: co-design nurse-led care with the people who deliver it, implement it with the right governance and funding architecture, and evaluate it in ways that demonstrate value for patients, practices and the health system.