Collaborative arrangements and privately practising nurse practitioners in Australia: results from a national survey

Abstract

Objective. Since the introduction of legislative changes in 2010, services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for subsidisation through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). To provide eligible services, PPNPs must collaborate formally with a medical practitioner or an entity that employs medical practitioners. This paper provides data from a national survey on these collaborative arrangements in Australia. The aim of the study was to evaluate the impact of PPNP services on patient access to care in Australia.Methods. PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed using thematic analysis. Seventy-three surveys were completed.Results. Ninety-three per cent of participants reported having a collaborative arrangement in place. Frequency of communication ranged from daily (27%) to never (1%). Participants reported that collaborative arrangements facilitate learning, patient care and offer support to PPNPs. However, for some PPNPs, organising a formal collaborative arrangement is demanding because it is dependent on the availability and willingness of medical practitioners and the open interpretation of the arrangement. Only 19% of participants believed that collaborative arrangements should be a prerequisite for PPNPs to access the MBS and PBS.Conclusion. Although there are benefits to collaborative arrangements, there is also concern from PPNPs that mandating such arrangements through legislation presents a barrier to establishing PPNP services and potentially reduces patient access to care. Collaboration with medical practitioners is intrinsic to nursing practice. Thus, legislating for collaborative arrangements is unnecessary, because it makes the normal abnormal.What is known about the topic? To access the MBS and PBS, PPNPs are required by law to have a collaborative arrangement with a medical practitioner or entity that employs medical practitioners. To date, the effects of these collaborative arrangements on PPNP services in Australia have not been known. What does the paper add? This paper provides unique data from a national survey on collaborative arrangements between PPNPs and medical practitioners in Australia. What are the implications for practitioners? Although there are benefits to collaborative arrangements, there is also concern that mandating such arrangements presents a barrier to establishing PPNP services and potentially reduces patient access to care.

Practice activities of privately‐practicing nurse practitioners: Results from an Australian survey

“…As previously stated, this could be due to the fact that, in the public sector, salaried NPs are called upon to do more indirect care, whereas in the private sector, their income depends on direct clinical care. Nevertheless, the amount of time that PPNPs report they spend delivering care to patients goes some way toward suggesting that, in greater numbers, PPNPs have a significant role to play in Australia's health reform agenda in meeting the burgeoning demand for healthcare services, particularly in the community setting where they are predominately based (Currie et al, ).…”

“…A report on general practitioner practice activities in 2009–2010 identified that the mean length of “claimable” MBS/Department of Veterans Affairs encounters was 15.3 min (Britt et al, ). The difference in time spent with patients between PNPP and medical practitioners could be a consequence of the significant chronic and complex care focus that a high proportion of PPNP services have, and the recurrent nature of PPNP case load (Currie et al, ). It could also be as a result of the holistic span of a NP scope of practice, which frequently encompasses not only the physical but also the social, psychosocial, cultural, and spiritual aspects of care (Watts et al, ).…”

“…An electronic survey was designed using the Survey Monkey platform, and was available for 6 weeks (February–March 2015). The survey questions were informed following a review of current literature (Currie et al, ), and focused on the following four aspects of PPNP practice: workforce characteristics (Currie et al, ), collaborative arrangements (Currie et al, ), access to MBS and PBS, and practice activities. There were 82 questions included in the survey; the majority were quantitative “yes”/“no” or multiple choice questions, with a free text space to explain the reason for the participant's answer.…”

“…NPs practice in a private capacity in all states of Australia and the Australian Capital Territory, the only jurisdictional exception being the Northern Territory (Currie, Chiarella, & Buckley, ). PPNPs work predominantly in community and primary care settings, such as community mental health roles (Raeburn, Hungerford, Sayers, Escott, Lopez & Cleary, ), in general practice surgeries (Helms, Crookes, & Bailey, ), and are integrated within pharmacies in a primary healthcare and health‐promotion role (McMillan & Emmerton, ).…”

“…PPNPs work predominantly in community and primary care settings, such as community mental health roles (Raeburn, Hungerford, Sayers, Escott, Lopez & Cleary, ), in general practice surgeries (Helms, Crookes, & Bailey, ), and are integrated within pharmacies in a primary healthcare and health‐promotion role (McMillan & Emmerton, ). The main focus of Australian‐based PPNP services is the provision of chronic and complex care (Currie et al, ). Reported in the literature are issues surrounding the sustainability of PPNP services, including the range of MBS items (Elmer & Stirling, ), the inadequate scheduled fee allocated to NP MBS items (Currie et al, ; Helms et al, ), and the mandatory requirements for collaborative arrangements (Currie, Chiarella, & Buckley, ; Schadewaldt, McInnes, Hiller, & Gardner, ).…”