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Nurses front and centre of reform

Minister says nurses are the backbone of health reform.

If we get it right for you, the nurses, it’s likely we will be getting it right for the patients.
These are the words of health minister Nicola Roxon, spoken to the first group of nurses she has stood in front of since the release of the budget.

Addressing nurses from across the country at the Royal College of Australia’s Nursing Summit in Canberra last week, Roxon said nurses were central to the government’s health reforms.
This, she said, was recognised in the budget announcements which nurses figured high in.
“The health system doesn’t work without nurses. Reform won’t work without nurses,” Roxon said.

“It is not an over-exaggeration to say they are the backbone of our health system. Not just in numbers, with nurses out numbering doctors four to one, but in the varied care they provide.”

As the case with all budgets, this year’s was met with mixed reactions, however overall the nursing profession has been positive on the $2.2 billion health investment.

The announcement receiving the most attention is the funding for more nurses working in general practice.

It will result in major and fundamental changes to patient care, which nurses will be required to provide, according to Professor Paul Arbon of Flinders University School of Nursing and Midwifery.

“More nurses employed in GP clinics across the country is a logical and necessary step forward in a community which is facing greater demands on its medical resources than ever before,” Arbon said.

“Nurses are the practitioners who spend the greatest amount of time with patients and their role in caring for our ageing population is about to expand enormously,” he said.

“Health services will need to be better at prevention, early detection and treatment and focus more on rehabilitation and care of patients within community settings. The importance of Australia’s nurses in achieving this health reform vision cannot be underestimated.”

Workforce problems in under pressure general practices will be alleviated with incentives to employ practice nurses to metropolitan areas, said Dr Emil Djakic, Australian General Practice Network chair.

“We have been calling for changes to this for years. Our studies show those 40 percent of GPs who don’t have a practice nurse don’t have one because they can’t afford it – despite the benefits to patients and help to GPs nurses bring,” he said.

“I now expect nurse numbers to increase by 2000 in two years, with 80 percent of practices employing a nurse.”

The Australian Practice Nurses Association has long been arguing that current funding of nurses in general practice has been “overly complicated, insufficient and not optimised the clinical contribution or whole patient approach for which nurses are renowned.”

“Replacing the current funding process, of practice nurse item numbers and the practice incentive payment nurse subsidy, with block grant payments will enable practices to tailor the nursing contribution to patient care to their particular community needs and to make the most effective use of specific nurse skills,” Anne Matyear, president of APNA, said.

“We know that other health systems with block grant funding for nurses overseas have experienced a radical increase in nursing roles and we hope to see the same response here.”

APNA has been arguing for a number of years that the “for and on behalf of the GP” item numbers for nursing activity have been an inefficient way of funding the nursing role.

Under this design, Matyear said it has been a static dollar amount regardless of complexity of care or qualification of the nurse; created more red tape and an incorrect perception of individual GP liability for nursing care and; rewarded certain tasks over others regardless of practice community needs.

The current PIP subsidy, which is to be replaced, has also been insufficient in the amount of payment, restricted to certain geographical areas and the same amount regardless of the qualification of the nurse, Matyear said.

“While we welcome the funding as a significant increase in support for nursing care in the primary care setting, it will effectively subsidise one registered nurse per three fulltime GPs up to a maximum of $125,000. A one to one nurse to GP ratio results in optimal multidisciplinary care for the community, as has been evidenced overseas and therefore should the standard we should be working towards in Australia.”

The government also needs to embrace the role of nurses and midwives in community and primary health care beyond the general practice environment, said Debra Cerasa, RCNA CEO.

“Nurses and midwives must not be limited to the provision of funding through general practice, as this model imposes a significant limitation on the reach, accessibility and flexibility of nursing and midwifery services,” Cerasa said.

The provision of funding to build a sustainable and skilled aged care workforce is another key element.

Trialling new models of care to expand and improve the role of nurse practitioners in aged care are seen as crucial in this.

“We have lobbied extensively for a national examination of funding options to allow nurse practitioners to manage the health care needs of aged care populations. This is positive development for aged care services and the nursing profession,” Cerasa said.

Calling the 2010 budget “a huge win for aged care nurses, care staff and the residents they care for”, Ged Kearney, ANF general secretary said the $60 million education incentive for aged care nurses was a particular highlight.

“This will lead to thousands of nurses, assistants in nursing (AINs) and personal care workers upgrading their skills, helping them to stay working in the aged care sector and ensuring high quality care is delivered,” she said.

“This is vital given the number of nurses in aged care actually declined by 4000 between 2003 to 2007 while the number of residents increased by 15,000 in that time.”

The introduction of a national licensing system for AINs and personal care workers was welcomed across nursing groups.

RCNA is also pleased to see funding for a rural locum program for 3000 nurses.

However, Cerasa said it was disappointing that the government failed to recognise RCNA’s push for a national rural nursing and midwifery work environments and lifestyle assessment.

“We cannot lose sight of our rural and remote colleagues and is an issue that we will continue to work on,” she said.

There was also disappointment from some mental health groups that there was not enough “new funding” announced to tackle the nation’s mental health problems.

Where the money went

• $390 million to better support practice nurses in GP clinics
• $60 million in training and education incentive payments to assist nurses and personal care workers in aged care
• $69 million to establish the first ever rural locum scheme for nurses, build nursing careers and support nurse practitioners in aged care
• Invest $128 million over four years to help attract and retain nurses in the aged care sector
• A further $13 million over two years provided under the Mental Health Nurse Incentive program to employ an additional 136 mental health nurses and provide an estimated 11,700 extra services
• $772 million to improve access to GPs including an after hours service
• $467 million to give every Australian an electronic health record by mid-2012
• $400 million to set up new hospital funding arrangements and performance reporting

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