Nurses have been working in general practices in Australia for several decades (ADGP 2006; Halcomb, Patterson & Davidson 2006). However there has been an increasing focus on this domain of nursing practice in recent years, especially since 2001 when Federal Government initiatives targeting nursing in general practice were introduced. During this period, the number of nurses working within general practice has increased substantially (ADGP 2006; AIHW 2005). Much of this expansion has been driven, resourced and supported by Divisions of General Practice, and their state and national support organisations, collectively known as the Divisions of General Practice Network.
DIVISIONS OF GENERAL PRACTICE IN AUSTRALIA
Divisions of General Practice have evolved in Australia since 1992, as a (primarily) government funded mechanism for providing the general practice profession with 'effective, resourced, regionally based organisations that could interact with other health care providers' (Weller & Dunbar 2005). In 2007, there are 118 Divisions of varying size and capacity distributed around Australia (ADGP 2006). The Divisions Network is supplemented by eight State Based Organisations (SBOs), whose role is to provide support to Divisions within their jurisdiction, and the Australian General Practice Network (AGPN, formerly ADGP), who are the peak national body.
Divisions arose from the provision of government funding to what were initially local collectives of general practitioners, and have evolved into a rich, diverse and strongly coupled network of organisations that provides infrastructure to support training, education, business development, information management, project implementation, research and innovation for the general practice profession. Weller and Dunbar (2005) suggest that Divisions have 'played a fundamental role in shaping contemporary Australian general practice'. The organisational structure they provide has created a mechanism for considering general practice as an Organised' entity within the health care system.
As they have evolved, there has been an increasing onus on Divisions to generate or contribute to the improvement of health outcomes at a population health level and in a demonstrable way (Divisions of General Practice Review Panel 2003).The Commonwealth Government has articulated a range of priorities (detailed in Table 1) for strengthening primary care through Divisions (Australian Government Department of Health & Ageing 2004).
Divisions have parallels in other countries. Most notable in their similarity are Independent Practice Associations (IPAs) in New Zealand and Primary Care Trusts (PCTs) in the United Kingdom (Weller & Dunbar 2005). While these organisations have considerable similarity, there are also notable differences. Primarily, these relate to the budget holding and other service delivery responsibilities undertaken by IPAs and PCTs, which have not yet been broadly embraced by Divisions or Government in this country.
Divisions have, however, been keen students of developments taking place overseas, especially in countries where practice nursing is more established. It is generally accepted that there have historically been few practice nurses in Australia relative to the United States, Great Britain and New Zealand (Tolhurst et al. 2004).
Primary care nurses in the US are numerate, widely distributed and relatively autonomous (Hooker 2006), but comparison is complicated by the presence of additional professionals such as Physicians Assistants, which currently have no formal equivalent in the Australian system; the dominant role of Nurse Practitioners; the different funding arrangements for primary care services; and the apparent availability of primary care physicians (Green & Phillips 2005; Hooker 2006). The primary care nursing role has evolved within a considerably different context to Australia, and there is no real equivalent to Divisions of General Practice. …