Nurse Practitioner led General Practice
What is required to provide a primary health care service by a nurse practitioner? Firstly, a deep breath, absolute determination, and genuine belief in the knowledge and advanced skills that the nurse practitioner role offers. A decision right from the outset to “choose” what to listen to. There would be many opinions!
Lets just go back a bit…
For the twenty years prior to buying the Pleasant Point Health Center I had been working in the primary health care arena and more specifically in rural general practice. I had been practicing in an advanced position for the previous ten years with much of my work being in an autonomous role. (eg. PRIME, nurse led clinics in small rural towns and then on Pitt Island as the only health provider). Working along side GPs for 20 years also meant I had a wealth of knowledge gained from observing and learning from their expertise.
I knew what I was capable of doing with the experience I had, but needed this constructed in an education framework that provided me with a qualification that gave a defined scope to my practice. My prior nursing experience was a sound base on which to further develop physical assessment, pathophysiology, pharmacology and diagnostic reasoning skills. A Clinical Masters (of Nursing) gave me the education framework and then the “Nurse Practitioner” qualification allowed me the legal ability to work within a nursing scope of practice to do what I wanted to do. I studied while working full time in general practice, doing after hours, on-call and PRIME. The advantage of studying and working simultaneously meant I was able to put into practice the skills I was learning on a daily basis and this quickly cemented my knowledge.
Once qualified as an NP, I worked in a small general practice with readily available support by a GP who acknowledged my ability and provided me with the opportunity to consolidate my NP expertise.
SO… back to the question… what is required…
- a contract with the “PHO” to provide a General Practice / Primary Health Care service
- access for patients to “medical care” within 24 hrs if needed
- take part in the after hours roster to ensure 24 hour access to health care
As I was able to cover the above mentioned requirements the equivalent of the South Canterbury PHO agreed to giving me a contract.
The contract was covered under the The PSAAP agreement (2013) stated a patient could be registered with an appropriately qualified Health Practitioner. That meant a Nurse Practitioner could have a registered client base and be paid capitation just as a GP has been historically. “The PHO … uses its best endeavours to ensure that any Contracted Provider who is a Practitioner, or any Practitioner employed or contracted by a Contracted Provider to provide the Services, has the qualifications, accreditation, experience, competency and availability necessary to enable it to perform the subcontracted Services in accordance with this Agreement. “ (https://tas.health.nz/assets/Planning-and-Collaboration/Primary-Care/Archived-2016). According to this here was no reason why I couldn’t provide the service.
Access to ‘medical care‘ was originally provided through a variety of means Firstly the GP I bough the practice off was available any time I required advice, and I was able to have the person seen by him at his or my practice as needed. I also had access to the Emergency Department medical providers for advice. I had already nurtured relationships with different secondary care Doctors whom I could phone at any time to discuss a patient. The plan was always to have a GP 1-2 days a week to complete the model of care I wanted to provide. We then had a GP work 1-2 days a week in the practice.
After Hours Service was provided bu the Timaru After Hours service (TAHS). They would not allow an NP to take part on the roster as they required a ‘Dr’ to provide the after hours care. (I had been doing rural after hours including PRIME for 12 years at that time) In order to fulfill the requirements of the contract I employed a GP to cover my share of the roster for the first two years, at which time I requested a transfer of the after hours care to the “rural roster” , where I had been providing after hours cover as a locum for the DHB for two years prior. The Geraldine/Temuka GPs allowed my practice to come under their after hours cover. Geographically this made more sense as Pleasant Point is situated 20 mins out of Timaru, similar to the distance between Temuka and Timaru.
SO… we met the criteria to provide a PHC service that is funded through capitation as any other General Practice. Three and a half years later the enrolled population has increased from less than 1000 to over 1700.