27 July 2022
Practice nurses could provide a cash injection
Time is money, and letting nurses give vaccinations without GP supervision could be a boost for both.
A petition to allow practice nurses to give flu jabs could also be shot in the arm for general practice billings.
It comes as GPs’ resources remain stretched to breaking point by high covid numbers and the severe flu season.
“Aussie GPs are calling on the federal government to allow practice nurses to administer flu vaccines under the supervision of a GP in general practices,” stated the petition, which was launched last month by Associate Professor Charlotte Hespe, chair of the RACGP NSW/ACT faculty.
“We want the government to create a new Medicare Benefits Schedule item number for this purpose, based on existing item 10988 (an immunisation provided to a person by an Aboriginal and Torres Strait Islander health practitioner).”
The change would free up GPs’ time and cut waiting times for patients, but it’s one the government has largely steered clear of to date.
“The government is very, very reluctant to fund anything under Medicare in general practice that doesn’t involve the GP doing it,” Professor Hespe told TMR.
“If you’re in a rural setting, you get an incentive to employ a nurse and you get bits and pieces, but there is no funding aligned with nurses doing any [increased] scope of practice.
“We know that if we give a whole lot of our chronic disease work to a chronic disease management nurse, often they do it really well, but they can’t bill any of it. That has to be done by the GP, and the GP can only do it if they actually see the patient.
“So, GPs have always been really nervous about how much they do or don’t use nurses in case they get into trouble because they’re not the one providing a service,” she said.
“Rather, we need to have it billed by the doctor who owns it, but for the service to be done completely safely by the nurse.”
Expanding nurses’ scope of practice could open up a new revenue stream for general practices but the call for change could also face resistance from government.
“This is just a little stepping stone,” said Professor Hespe. “We need to start bringing income into practices for the work our practice nurses do. I think one of the reasons why this was rejected when we asked for it was that one person in the department really, really, really doesn’t want to open up any other Medicare funding streams, and they’re very nervous about it.
“I believe we need to call out these faceless bureaucrats. They hide behind the minister and the minister says no because the person in the department has said no. Everybody’s saying it’s so hard to get GPs to do anything, but GPs are constrained by what they can do.”
With GP and pharmacy groups at loggerheads over the North Queensland pharmacy pilot, broadening practice nurses’ scope of practice might raise the ire of the pharmacy sector.
Professor Hespe said while she was concerned about pharmacists providing on-premises services that lay outside their level of skill and training, there was still a role for them as part of a general practice team –under certain conditions.
“When a nurse has access to the same electronic medical record as the doctor, they’re working alongside the GP,” she said. “They’re part of a team where they work together. Now if I have a pharmacist who has the same access to my files and is working with me as part of the team, then I would be far more open to having pharmacists have an increased scope of practice as well. But it’s about an appropriate scope of practice.”