Following the funding trail: Financing, nurses and teamwork in Australian general practice

Abstract

BackgroundAcross the globe the emphasis on roles and responsibilities of primary care teams is under scrutiny. This paper begins with a review of general practice financing in Australia, and how nurses are currently funded. We then examine the influence on funding structures on the role of the nurse. We set out three dilemmas for policy-makers in this area: lack of an evidence base for incentives, possible untoward impacts on interdisciplinary functioning, and the substitution/enhancement debate.MethodsThis three year, multimethod study undertook rapid appraisal of 25 general practices and year-long studies in seven practices where a change was introduced to the role of the nurse. Data collected included interviews with nurses (n = 36), doctors (n = 24), and managers (n = 22), structured observation of the practice nurse (51 hours of observation), and detailed case studies of the change process in the seven year-long studies.ResultsDespite specific fee-for-service funding being available, only 6% of nurse activities generated such a fee. Yet the influence of the funding was to focus nurse activity on areas that they perceived were peripheral to their roles within the practice.ConclusionsInterprofessional relationships and organisational climate in general practices are highly influential in terms of nursing role and the ability of practices to respond to and utilise funding mechanisms. These factors need to be considered, and the development of optimal teamwork supported in the design and implementation of further initiatives that financially support nursing in general practice.

The Computerized Medical Record as a Tool for Clinical Governance in Australian Primary Care

“…Mobility of patients between practices means that they lack the stable population denominator of registration based systems such as those found in the UK or Netherlands. Funding is largely fee-for-service underpinned by a national insurance scheme, but there are many accessory payments [27] and other programs [28]. The CMR systems also allowed for different role-based access for nurses and receptionists.…”

Is the Counterweight Program a feasible and acceptable option for structured weight management delivered by practice nurses in Australia? A mixed-methods study

“…Funding mechanisms have the power to direct and expand the nurse's role; for example, under a GPMP, MBS service payments enable five visits to a practice nurse for chronic disease management (Halcomb et al 2008;Pearce et al 2011;McInnes et al 2017). Additional service payments to promote practice nurse involvement in obesity management have been suggested (Afzali et al 2014), as without adequate funding, practice nurse time is likely to be directed to other, more financially rewarded priorities (Nolan et al 2012).…”

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“…There is also a strong private hospital sector, and virtually all general practice is private practice. Private medical practice is underpinned by a federal universal health insurance scheme, called Medicare, that pays patients a rebate for visits to the doctor (or the doctor can accept as the full fee) [17]. People can also take out insurance for hospital costs.…”