Nurses perfectly able to do more

AUSTRALIA'S healthcare system is in desperate need of change.
Tinkering around the edges will not do the job. The National Health and Hospitals Reform Commission (NHHRC), expected to release its long-awaited interim report next week, was charged with a vital task. The commission consulted widely and has an opportunity to take the bull by the horns by recommending bold reforms to improve access and health outcomes for everyone.

Unfortunately, much of the focus on our health system is placed on the crisis facing large hospitals. A simplistic option of opening more beds is constantly put forward by some parties as the answer. But anyone can see that is a flawed response.

To start with, we don't have the workforce to care for the people in them. The only answer is to reduce the need for beds in the first place. Take the pressure off hospitals and leave them to the provision of tertiary health care, the ultimate and hopefully avoidable step in anyone's journey of wellbeing.

The role of primary healthcare services provided locally, by community health providers including general practices, should not be underestimated. We need a fundamental shift in the focus of health care, encouraging prevention, early intervention, and direct easy access to appropriately skilled professionals.

The economic crisis will undoubtedly cause future strain on the nation's struggling health system. As families experience job losses and lower incomes, the demand for scarce bulk-billing will rise. We know that already health costs are weighed up by many people against basic needs such as food and rent, and often get put way down the list of priorities.

A brave approach to healthcare reform and access issues must begin with alternative models of funding. Currently the vast majority of federal funding goes directly to GPs. While GPs play an essential role in primary health care, they are not the only health professionals able to deliver effective primary and preventative healthcare services.

Nurses are increasingly playing a vital role in general practice. Doctors and the Australian Medical Association are keen to see nurses' roles in general practice extended as long as they remain under a GP's direction and Medicare rebates for their services go to a supervising GP.

Enhancing the role of practice nurses is well supported, but of totally no use to communities that don't have a GP. And why limit the nurses' roles to a fee-for-service based system where tasks are identified and funded item by item? The reality is that nurses provide nursing care, not bits and pieces of what a doctor does.

The two professions are independent of each other but complementary, and at times intersect or overlap. Why can't there be independent funding, free of the GP, for what a nurse does in a clinic -- or anywhere, for that matter?

An innovative and cost-effective initiative in general practice might involve block funding, where a nurse is employed on a salary to independently provide care, collaborating with other professionals as necessary.

Nurse-led clinics funded to order diagnostic tests or prescriptions would allow qualified nurses to manage chronic health conditions, such as diabetes. Nurses are adequately knowledgeable to make referrals to other health professionals, identifying potential or developing problems.

Nurses working collaboratively in this capacity would greatly improve the efficiency of the workforce. GPs' workloads would be dramatically reduced improving access to care for more people.

Australia's population is ageing; older Australians are less able to access timely health care for many reasons. One of the main reasons is their reduced mobility, making it difficult to get to health appointments when they cannot easily drive or use public transport. In Port Macquarie, NSW, an aged-care nurse practitioner is visiting the older community in their homes and saving the NSW Health Department millions every year in preventable hospitalisations. Imagine if these nurses could also order blood tests and medications for those people from their lounge room, something they are well qualified to do -- and already do in some instances.

Unnecessary trips to a GP for many older people or worse, an unnecessary admission to a hospital, could be avoided. This is a basic primary healthcare initiative that could be extended across the nation.

One can almost feel the health system sighing with relief just thinking about it -- not to mention the obvious benefits to those who are being cared for.

Aged care is the elephant in the room. No one wants to address it.

The needs of older Australians are placing huge demands on our system, and sadly, those needs are at best simply not met, or at worst totally neglected. The Australian Government must sort out aged care if it is ever going to fix the health system, and adequate primary healthcare services will be vital as people want to age in their homes.

Nursing homes must be adequately resourced as the mini-hospitals they now are, with appropriately skilled nursing staff and help to provide appropriate accommodation.

Focusing on primary health care to keep people well and out of hospitals won't work in isolation; Australia must also look at ways to employ the skills and expertise of health professionals efficiently, effectively and to their full capacity. Nurses are the largest part of the health workforce and they have a great contribution to make.

By Ged Kearney - federal secretary of the Australian Nursing Federation

Article from www.theaustralian.news.com.au