Anger at new 'barrier' to NP practise 22 April

Nursing leaders are angry and frustrated at moves to exclude nurse practitioner-led services from being eligible for general practice-only funding.

The outcry is in response to current contract negotiations proposing that a general practice team has to have both GPs and nurses. 

The government announced late last year that NPs and nurses could now join GPs in claiming GMS (general medical schedule) payments but the proposal on the table of primary health organisation (PHO) agreement negotiations would mean that only NPs and nurses working with a GP would be eligible for the funding.

“The general practice team definition recognises that the full range of first contact services in general practice are best delivered by a team of health professionals that includes doctors and nurses,” said the Ministry of Health in a statement.

But Memo Musa, the chief executive of the New Zealand Nurses Organisation and Professor Jenny Carryer, executive director of the College of Nurses disagree seeing it as another barrier to NPs helping meet patient needs.

They both argue that a general practice team can be made up of either a general practitioner and/or a nurse practitioner along with registered nurses and other health professionals.

“Those of us who have spent more than ten years now battling the tedious barriers to NP practice and to nurses practising at the “top of their licence” see this as a potential additional barrier,” said Carryer.

She also could not understand putting a “stranglehold” on the definition of general practice at a time when there was growing concern that it was getting “harder and harder” to find GPs to serve rural and vulnerable populations. “This is so contrary to notions of flexibility, responsiveness and sheer pragmatism. It also ignores considerable long-standing evidence that nurse practitioners are able to deliver safe and effective care in a highly cost effective manner.”

“One asks whose interests are being served?  It sure ain’t the patients.”

Musa said the proposed definition had the potential “to close the door” on nurse practitioners contributing to innovation in general practice that could lead to improved access and outcomes in primary care.

He added not allowing NPs to be eligible for the full range of funding opportunities in general practice was “a significant missed opportunity to provide effective care in areas that are already experiencing GP shortages”. “Excluding NPs from definitions of the general practice team may exacerbate inequalities in health.”

Cathy O’Malley, a Ministry of Health deputy director general and Jane O’Malley, Ministry of Health chief nurse, said in a joint statement  that the extension to allow nurses and NPs to claim GMS had been “carefully organised” as an enabler for “team-based integrated care” and to ensure there was “not a fragmentation of service”.

“This extension is not intended to apply to health clinics outside of general practice. It is however enabling of nurses, including nurse practitioners within general practice.”   

“The ministry will continue to work with the sector to ensure health practitioners working in other important models of care and settings, also have business models available to support those roles, including nurse practitioners who work outside general practice.”

Carryer said she did not want NP-led services to be an exemption to the general practice model or “an inferior desperation move”. 

“Nor do I want to see the sector expending the time and energy we’ve spent fighting all the other ridiculous barriers. Why would we set up another one?” 

“It’s about wasting people’s energy which should be directed at caring for people, not by jumping through hoops and endless bureaucratic garbage to do the glaringly obvious.”

The Ministry said the GMS subsidy represented only a small proportion of the total primary health care funding that nurses were able to access, including being able to enroll patients and receive capitation funding.