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SA union push for nurse-led centres

The South Australian branch of the Australian Nursing and Midwifery Federation has called for the state government to introduce nurse practitioner-led walk-in centres to ease the pressure on the state’s emergency departments.

Similar clinics have been set up in the ACT and overseas including in Britain and Canada but are yet to be widely adopted in Australia.

Union state secretary, Elizabeth Dabars, said the NP-led model would increase patient access to primary healthcare services.

A combination of nurse practitioners and advanced practice nurses would be used to provide one-off consultations to patients with minor illnesses such as coughs and colds, cuts, abrasions and simple fractures.

The union has also called for the nurse-led primary healthcare model to include chronic disease assessment and treatment for conditions such as asthma and diabetes, which would go beyond the current scope of the Canberra walk-in centre.

“We would like to see those centres located as close as possible to the community and to be co-located with health centres such as GP plus centres, so that they can make appropriate referrals to allied health and medical practitioners,” Dabars said.

She called on both sides of politics to commit to the implementation of four nurse-led walk-in centres for each local health network in metropolitan Adelaide and one clinic in one country cluster.

“We are very persuaded by the evidence both nationally and internationally that there is no evidence of an increase in adverse outcomes for patients. In fact, independent evaluations have demonstrated a significant improvement in patient satisfaction,” she said.

Dabars said international models demonstrated that nurse-led drop-in centres should be located in the community to reduce emergency department blockages.

She said nurse-led models in the community would operate in addition to nurse practitioners being employed in emergency departments. “We would be open to models that were collaborative in nature and included a GP. However, in the absence of that being accepted or considered feasible, we would advocate for models that were nurse-led only.”

However, SA Health’s executive director of health system performance, Jenny Richter, said walk-in community-based clinics were not generally equipped with the necessary equipment to complete a thorough patient assessment.

“Hospital ED nurse practitioners usually see patients with injuries or symptoms that require thorough assessment and often formal investigation ...This often requires access to appropriate equipment, such as X-ray machines, pathology services or specialist equipment, which are generally not available in walk-in community based clinics.”

Associate Professor Rhian Parker from the Australian Primary Health Care Research Institute said an independent evaluation of the Canberra clinic found high patient satisfaction with the service.

She said nurse-led models were useful in areas where there was a lack of health professionals working in primary healthcare. “Evidence from systematic reviews shows that nurses provide equal care to doctors in many areas in primary healthcare,” she said.

More than 30,000 people have attended the ACT Health Walk-In-Centre in its first two years, with a median wait of 20 minutes to receive treatment. An evaluation of its first year found 84 per cent of patients would recommend the walk-in centre to family and friends and 82 per cent said they would return to the clinic.

However, the evaluation said the centre did not reduce pressure on the ED, due to its co-location with the Canberra Hospital.

The Australian Nursing Federation ACT branch said nurse-led clinics offer an alternative healthcare option for patients, particularly where there is an acute shortage of bulk-billing GPs.

The ACT government is looking to expand the walk-in centres to a further two locations.

Linda Belardi

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