Primary health care nurses say there is an “urgent need” to re-examine the funding of general practices to provide more flexible funding for nurse-led services.
The call is made in a position statement released recently by the College of Primary Health Care Nurses NZNO and sent to the Minister of Health, Ministry of Health, and Health Workforce New Zealand.
Rosemary Minto, the College chair, said the aim of the statement (called italMaximising the Nursing Contribution to Positive Health Outcomes for the New Zealand Population***) was to provide a clear vision for primary health care nursing.
The statement said funding is the main motivator for encouraging change, and there is an “urgent need” to re-examine the effectiveness of capitation-based subsidies to private GP practices.
It said flexible funding is necessary to make the most of the health workforce team’s skills and “nurses must be as involved in the planning and funding of services as they are in delivering them”.
The statement goes on to say that primary health care nurses have developed innovative nursing service models, but to date, they are fragmented and need a proactive national approach to support them being established more widely.
“In some instances, such innovations have been disestablished regardless of their success in terms of population health outcomes.”
It adds that NZNO advocates for models of care that fully utilise the nursing scope and nursing expertise to “complement” and not substitute medical care. In addition, it states cohesive multidisciplinary teams were an essential component of effective primary health care services and general practice would be a “vital part” of meeting the aims of primary health care nursing aspirations.
Alternative purchasing models and having nurses as the key entry point to the primary health care team could “optimise” the use of funding, health workforce resources, increase people’s choices, and improve health equity.
“A wide range of initiatives including walk-in centres, nurse-led clinics, nurse practitioner positions, and nurse partnerships with other health professionals such as pharmacists, GPs, and specialists could provide safe, cost-effective, primary health care.”
The document also supports the Whanau Ora model and the development of “truly” integrated family health centres that fully use and integrate the skills of the health professional team.
Minto said it was using the position statement as part of the College’s discussions with the Ministry’s Chief Nursing Office team.
“(We) hope that HWNZ will recognise the value of having a clear vision for PHC nurses with some achievable outcomes and solutions, for example the proposed knowledge and skills programme (see below).”
Position statement recommendations
- Make nursing services the key entry point to primary health care to ensure all New Zealanders have access to comprehensive primary health care, including primary, child, and youth health, aged, and mental health care.
- Realign funding mechanisms for primary health care to remove barriers to the effective use of nursing skills to provide frontline care.
- Fund, via HWNZ, the ongoing development of a primary health care knowledge and skills framework, which includes second level and advanced nursing practice roles including nurse practitioners.
- Support the Whanau Ora model as an appropriate means of supporting families and communities to address their health and social needs.
- Progress the development of truly integrated family health centres (IFHC), with an emphasis on the mix of providers and services that will improve access for high need populations to their choice of provider.
- Require Primary Health Organisations and/or Management Service Organisations to actively pursue the development, advancement, and deployment of the primary health care nursing workforce including nurse practitioner and other nursing leadership roles.
