Practice nurses ease the strain on general practitioners, but not enough doctors and policy makers recognise their pivotal role, this report reveals.
Policy recommendations from the report
There are, in essence, two health policy problems for which nurses in general practice can provide a solution: (1) the need to find new models of clinical care for changing patterns of disease and population demographics and (2) the need to expand the health workforce at a time when the numbers of available doctors are falling. These two health policy problems are not completely unrelated, but it is useful to think of them as different problems, as their solutions require different policy emphases.
Policy solutions which focus on the nursing contribution to new models of primary care will:
- Encourage genuine collaborative work between nurses and doctors, and de-emphasise rather than promote traditional hierarchies
- Provide a platform for nurses to have some decision-making autonomy in general practice
- Recognise and foster nursing skill-sets in general practice, especially when these are complementary to the skill-sets of GPs
Evaluate in terms of clinical outcomes.
Policy solutions which focus on nurses as a solution to the health workforce undersupply in general practice will:
- Encourage task substitution with nurses performing clinical work that is currently, or has previously been, performed by doctors
- Recognise and respect the incumbency of the medical workforce in general practice, and clarify the locus of leadership for clinical care
- Risk perceiving nurse roles in terms of the ‘work’ that can be transferred from medical practitioners in order to save time and redistribute workload
- Evaluate in terms of clinical safety and cost.
Overall then, policy directed at finding health workforce solutions will tend to emphasise task transfer between disciplines and derive value from work that can be redistributed – often according to the hierarchical value of time for different disciplines. On the other hand, policy focusing on new models of clinical care will tend to emphasise complementary modes of working and highlight the supplementary components or additional quality that can be achieved through collaborative interprofessional practice.
These approaches are not mutually exclusive and can be leveraged off one another to some extent. Based on the findings of this study, the AGPNS investigators recommend a focus on complementarity and quality enhancement, from a policy perspective, as this will accommodate the workforce support needs of many general practices at the same time as allowing the nursing role development which is important to maximise return on investment and sustain these changes in the longer term.