Academic journal article Australian Health Review

Financial Viability, Benefits and Challenges of Employing a Nurse Practitioner in General Practice

Academic journal article Australian Health Review

Financial Viability, Benefits and Challenges of Employing a Nurse Practitioner in General Practice

Article excerpt


Nurse practitioners (NP) belong to a group of healthcare professionals who have been widely researched to examine their credibility, efficacy and utilisation in diverse healthcare settings internationally.1-7 Since the profession's birth in the USA in the 1960s, its model has extended to ~70 countries worldwide, including the United Kingdom, Canada, New Zealand and Australia.8The profession's aimis toimprove access totreatment, provide cost-effective care, target at-risk populations, provide outreach services to rural and remote communities and provide clinical mentorship and expertise.9

The first two NP were authorised in New South Wales in 2000 and numbers have grown steadily. The latest figures from July 2014 registration data collected by the Australian Health Practitioner Regulation Agency reveal that there are 1087 NP endorsed throughout Australia.10 The 2012 Australian College of Nurse Practitioners national member survey showed that NP working in Australia are practicing in diverse settings and speciality areas, ranging from emergency departments (30%) to general practice environments (8%), with the majority (71%) working solely for the public sector. When asked whether they wouldbe opening theirown private healthcare-related business in the next 5 years, 15% of NP responded in the affirmative.11

Given the above information and the Australian Government emphasis on building a safe, sustainable, efficient and efficacious primary healthcare workforce that meets the requirements of all communities,12,13 NP are beginning to transition to general practice to meet health system demands. On 1 November 2010, it became possible for Australian NP to access the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) as autonomous and collaborative healthcare providers.14 Not only did this legislation make financially sustainable private-sector practice more achievable, but it allowed healthcare consumers to seek MBS- and PBS-subsidised care from an NP without financial penalty. These factors, along with government-funded initiatives looking at alternative models of NPdirected healthcare provision in the aged-care sector,15 have further bolstered NP expansion into private practice. Data from the Australian Medicare Statistics website demonstrates that MBS-billable items by NP are increasing each financial year, especially in Western Australia and Queensland,16 where policy and legislation have facilitated alternative NP business-practice models.17-19

Despite these factors, growth in private general practice by NP has been slow and has not met all expectations.20,21 Central to this issue is national debate about the financial viability of collaborative NP models in private practice.22-26 There are many reasons for this, which primarily revolve around the inability of NP and medical practitioner to establish functional, bidirectional, collaborative arrangements27 and the favouring of traditional hierarchical paradigms, as opposed to team-care environments, which share the financial and logistical burdens of care provision.28 Anecdotal evidence from online forums, panel interviews andpresentations atnational conferencesthatcater to NP interests have revealed NP fears of leaving longstanding financially secure and senior public-sector positions, difficulties with practice startup costs v. cost recovery, and a perceived inability to translate public-sector speciality practice into private-sector generalist practice environments.29-31 This may suggest a lack of understanding of how to translate theoretical NP business models into real-world practice.

The purpose of this case study is to further illustrate the realworld translation of one of the theoretical NP business models presented in discussion papers published by the Australian Medicare Local Alliance.18,32 There is a distinct paucity of empirical evidence in the Australian literature that demonstrates the financial implications of NP working in private general practice. …

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