GP leaders respond to nurse leader frustration at new NP “barrier”

15 May 2014

Promoting integration and preventing ‘rogue behaviour’ is behind negotiations to stop nurses outside general practice from claiming GMS funding, say GP leaders.

Nurse leaders have expressed anger and frustration that the proposal to extend GMS (general medical schedule) payments to only nurses and NPs working with GPs would create new barriers for nurse practitioners stepping in to serve rural and high need communities. (See earlier article)

The government announced late last year that NPs and nurses could now join GPs in claiming GMS payments for patients they see. But the proposal on the table of primary health organisation (PHO) agreement talks means the GMS extension will only apply to members of a general practice team; which, under a new definition, must include both GPs and nurses.

Dr Kate Baddock, chair of the General Practitioner Council of the New Zealand Medical Association (NZMA), says requiring GMS-claiming nurses to be part of a GP team was to “preclude some rogue behaviour in primary care”.

“There were some situations where they felt that there may be health practitioners who may try and play the new system if the GMS subsidy business rules were not made very tight,” said Baddock.  “The exploitation (of GMS) could take place by GPs, it could take place by nurses, it could take place by anybody…if they didn’t define the general practice team in a way that made it clear…”

Dr Jo Scott-Jones, chair of the Rural General Practice Network, said the network saw value in all members of the general practice team in rural areas including community health workers, enrolled nurses, registered nurses, NPs and GPs alongside administrative staff and hospital-based staff.

“Without everyone working together we cannot do our jobs,” he said in a written statement.  “It is very easy to set up divisions between providers and professional groups. There is a regrettable tendency for us to talk about “scopes” of practice, not as ranges of expertise that can guide training, but as strictly bounded areas of practice that put divisions between professional groups and that do not recognise the skills and knowledge and wisdom that each health professional working in a rural community can develop.”  (See also opinion from Rural General Practice Network deputy chair and NP Sharon Hansen)

Baddock also stressed that NZMA believed “general practice in primary care in the 21st century needs an integrated approach”.   “That means not GPs or NPs but GPs and NPs working as part of general practice teams.”

In response to questions over situations where an NP was working in a remote or high needs area that struggled to attract GPs she said that general practice teams did not need to be at a single place at a single point in time.

“Very frequently such teams are virtual and they cover large geographic areas," said Baddock." But we do believe that GPs and NPs should be working alongside each other within an integrated approach.”

Baddock said allowing an NP-only practice to be considered a general practice was a divisive approach and “under the guise of diversification you end up fragmenting care”.  “We are trying to keep an integrated care approach going in this day and age because that is what is best for patients.”