Overview

Nurses play a critical role in dealing with problems of access within the primary health care (PHC) system. The role and scope of nursing in PHC is continually evolving in response to various changes/pressures in the health needs of Australian communities. Such changes/pressures include an ageing population, which places greater demand on health resources, coupled with PHC workforce shortages. The multidisciplinary role of nurses as health care provider, educator and advocate means the strain on other PHC resources can be ameliorated through integrated practice involving both general practitioners (GPs) and nurses. This Guide provides information on the role of Australian nurses in providing PHC as part of a reformed health system. It outlines recent developments to the role and activities of nurses in Australian PHC programs and worthwhile readings that provide further information on the crucial role of nurses in contemporary PHC delivery.
For more information:

SA Health: Strategy for Planning Country Health Services in SA
Australian Practice Nurses Association: Primary Health Care Consensus Statement
Australian Nursing Federation: Fact sheet 5 A snapshot of nursing roles in primary health care

Nurses and Australian Primary Health Care

According to the report Primary health care reform in Australia (Archived) (report to support Australia's first National Primary Health Care Strategy), the participation and role of nurses in the delivery of PHC services within general practice settings has substantially increased.The number of  registered / enrolled nurses employed in general practice (termed 'practice nurses') has increased from approximately 3 200 practice nurses in 2003 to approximately 8 200 practice nurses in 2007.

More information on health reform available from the PHCRIS Getting Started Guide Introduction to Australian health reform

What is the scope of the nursing role in PHC? What are the benefits of nurses in general practice?

Nurses can work effectively and collaboratively with GPs to deliver a range of PHC services. They play a key role in supporting patients in the optimal management of their health conditions, leaving GPs time and resources to allocate to more complex clinical care. Australian practice nurses undertake a broad range of health care activities, sometimes unrecognised under the current financing arrangements. These activities include:

• facilitating / providing preventative health education programs
• delivering quality chronic disease management and care coordination
• supporting patients with self management of chronic conditions
• monitoring and facilitating patient recall and reminder systems.

Among the benefits of the expanding role of nurses are reducing GPs workloads, increasing collaborative care between GPs and nurses, and enhancing the quality of care delivered. The Australian Journal of Advanced Nursing documents many of these benefits. In particular see:  How general practice nurses view their expanding role.

Changes, funding arrangements and progress

Practice Nurse Incentive's program
The role of the practice nurse will further expand through the Australian Government's commitment to reform including support and funding of nurse positions within general practice. From 2011-12, the Government will introduce a new Practice Nurse Incentives program, which will provide funding to practices to support the employment of practice nurses. It is expected the new funding arrangements will not only increase the number of practice nurses but will provide greater flexibility for practice nurses to focus on areas of greatest need. This will allow GPs to focus on more clinically complex care.
For more details, see the Supporting practice nurses (Archived) fact sheet on the Goverment's yourHealth website.

Medicare rebates
Medicare rebates expanded in November 2010, enabling nurses to receive rebates for services they provide outside of public hospitals (eg. in general practice settings). Rebates for nurses under the Pharmaceuticals Benefits Scheme have also been approved by federal parliament.

For further details see:

• Australian Government Department of Health and Ageing: MBS Items - Medicare benefits for non-directive pregnancy support counselling services
• Nurse Practitioners Clinic Australia Medicare Rebates Available
• Medicare Australia - Nurse practitioners and midwives

The Royal College of Nursing Australia makes suggestions for further developing the role of nurses in PHC. Two of these suggestions are: establishing funding incentives to increase the number of specialised advanced practice nurses and nurse practitioners; and establishing a national funding initiative for supporting research in the area of nursing.
For more details, visit the RCNA website: Primary health care in Australia: A nursing and midwifery consensus view [PDF:4.15MB]

What nurses are achieving in Primary Health Care? Examples of Australian programs

Primary Health Care Nurses program
This program aims to enhance primary health care services for smaller communities (eg. populations less than 1 000) within the Riverina boundary. Nurses are working collaboratively with GPs to provide access to clinical care, health promotion and chronic disease education and support. Nurses provide a broad range of clinical nursing services, such as: vaccination, wound management, preventive women's health, health assessment for all ages and chronic disease education.

Nurses' role in responding to influenza pandemics
Practice Nurses play an essential role in delivering care and advice in pandemic situations. The Australian Nursing Federation and Royal College of Nursing provide guidelines for practice nurses to respond to an influenza pandemic. These guidelines emphasise the nurses role in preparing and managing the general practice response to a pandemic. Further information can be found at the Australian Nursing Federation website: joint guideline: Influenza Pandemic [PDF:44KB]

Nurses in the community
In some areas of Australia, nurses have made a significant impact on community health. Community health nurses provide a comprehensive range of health promotion, early identification and intervention services to children, young people, adults and their families. The work of community nurses is supported by the Community Health Nurses Western Australia (CHNWA), which developed the Competency Standards for Community Health Nurses.

Nurses in Northern territory high school
Some programs have seen nurses' roles moving beyond health care settings and into community settings such as schools. For example, nurses in a Northern Territory high school facilitate and support many health related programs for students and staff. The nurses' role in this environment is to collaborate with school communities and professional staff in activities such as the implementation of health programs, undertaking health assessments, prescribing medications, making referral and preventive health care. For more details see:

Saint-Yves M. (2010). First Year Health Activities in a Northern Territory of Australia High School: Role of the School Nurse, The journal of the royal society for the promotion of health, 108(1), 20-26 (Accessed October 14, 2010).