Advancing general practice nursing in Australia: roles and responsibilities of primary healthcare organisations

2017 ◽  
Vol 41 (2) ◽  
pp. 127 ◽  
Author(s):  
Riki Lane ◽  
Elizabeth Halcomb ◽  
Lisa McKenna ◽  
Nicholas Zwar ◽  
Lucio Naccarella ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Leadership Development ◽  
Postgraduate Education ◽  
System Level ◽  
Delphi Consensus ◽  
Practice Nurses ◽  
Care Services ◽  
Primary Care Services ◽  
Australian General Practice

Objectives Given increased numbers and enhanced responsibilities of Australian general practice nurses, we aimed to delineate appropriate roles for primary health care organisations (PHCOs) to support this workforce. Methods A two-round online Delphi consensus process was undertaken between January and June 2012, informed by literature review and key informant interviews. Participants were purposively selected and included decision makers from government and professional organisations, educators, researchers and clinicians from five Australian states and territories Results Of 56 invited respondents, 35 (62%) and 31 (55%) responded to the first and second invitation respectively. Participants reached consensus on five key roles for PHCOs in optimising nursing in general practice: (1) matching workforce size and skills to population needs; (2) facilitating leadership opportunities; (3) providing education and educational access; (4) facilitating integration of general practice with other primary care services to support interdisciplinary care; and (5) promoting advanced nursing roles. National concerns, such as limited opportunities for postgraduate education and career progression, were deemed best addressed by national nursing organisations, universities and peak bodies. Conclusions Advancement of nursing in general practice requires system-level support from a range of organisations. PHCOs play a significant role in education and leadership development for nurses and linking national nursing organisations with general practices. What is known about the topic? The role of nurses in Australian general practice has grown in the last decade, yet they face limited career pathways and opportunities for career advancement. Some nations have forged interprofessional primary care teams that use nurses’ skills to the full extent of their scope of practice. PHCOs have played important roles in the development of general practice nursing in Australia and internationally. What does this paper add? This study delineates organisational support roles for PHCOs in strengthening nurses’ roles and career development in Australian general practice. What are the implications for practitioners? Effective implementation of appropriate responsibilities by PHCOs can assist development of the primary care nursing workforce.

Polypharmacy perspectives in general practice environments

2019 ◽  
Vol 30 (7) ◽  
pp. 342-347
Author(s):  
Gerri Kaufman
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Continuing Professional Development ◽  
Adverse Outcomes ◽  
Practice Nurses ◽  
Care Services ◽  
Primary Care Services ◽  
Medication Reviews ◽  
Funding Cuts

Practice nurses need to keep up-to-date with the latest prescribing guidelines, especially for patients taking multiple medications. Gerri Kaufman discusses some of the challenges facing polypharmacy and considers the roles of deprescription and medicines reviews Polypharmacy refers to the use of multiple medicines. A combination of medicines can be appropriate and beneficial for the patient; however, polypharmacy can also be problematic where the risk of harm outweighs the benefits of treatment. Polypharmacy is associated with increasing age, the presence of multi-morbidities, a culture of single condition guideline-based prescribing, obesity and lower wealth. Managing polypharmacy is a challenge for prescribers working in general practice and primary care. Polypharmacy is associated with adverse outcomes, including adverse drug reactions, falls, increased length of stay in hospital, and mortality. Vigilance around the safer aspects of prescribing, undertaking structured medication reviews and deprescribing are considered important in addressing issues with polypharmacy, and enhancing the management of patients on multiple medicines. Comprehensive guidance is available on the medication review process and deprescribing; however, the process is time-consuming, complex and requires investment. The NHS Long Term Plan put forward proposals to increase investment in primary care services, which include addressing medication safety. Workforce shortages and funding cuts for continuing professional development are both perceived as barriers to its implementation. Both individual prescribers and the systems in which they work are accountable for improving safe medicine use in polypharmacy.

scholarly journals Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care

2019 ◽  
Vol 69 (686) ◽  
pp. e595-e604 ◽  
Author(s):  
Victoria Hammersley ◽  
Eddie Donaghy ◽  
Richard Parker ◽  
Hannah McNeilly ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Technical Problems ◽  
Face To Face ◽  
Information Giving ◽  
Care Services ◽  
Primary Care Services ◽  
Quasi Experimental ◽  
Primary Care Clinicians

BackgroundGrowing demands on primary care services have led to policymakers promoting video consultations (VCs) to replace routine face-to-face consultations (FTFCs) in general practice.AimTo explore the content, quality, and patient experience of VC, telephone (TC), and FTFCs in general practice.Design and settingComparison of audio-recordings of follow-up consultations in UK primary care.MethodPrimary care clinicians were provided with video-consulting equipment. Participating patients required a smartphone, tablet, or computer with camera. Clinicians invited patients requiring a follow-up consultation to choose a VC, TC, or FTFC. Consultations were audio-recorded and analysed for content and quality. Participant experience was explored in post-consultation questionnaires. Case notes were reviewed for NHS resource use.ResultsOf the recordings, 149/163 were suitable for analysis. VC recruits were younger, and more experienced in communicating online. FTFCs were longer than VCs (mean difference +3.7 minutes, 95% confidence interval [CI] = 2.1 to 5.2) or TCs (+4.1 minutes, 95% CI = 2.6 to 5.5). On average, patients raised fewer problems in VCs (mean 1.5, standard deviation [SD] 0.8) compared with FTFCs (mean 2.1, SD 1.1) and demonstrated fewer instances of information giving by clinicians and patients. FTFCs scored higher than VCs and TCs on consultation-quality items.ConclusionVC may be suitable for simple problems not requiring physical examination. VC, in terms of consultation length, content, and quality, appeared similar to TC. Both approaches appeared less ‘information rich’ than FTFC. Technical problems were common and, though patients really liked VC, infrastructure issues would need to be addressed before the technology and approach can be mainstreamed in primary care.

scholarly journals Seeking Healthcare During Lockdown: Challenges, Opportunities and Lessons for the Future

2021 ◽  
Author(s):  
Fiona Imlach ◽  
Eileen McKinlay ◽  
Jonathan Kennedy ◽  
Megan Pledger ◽  
Lesley Middleton ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Health Services ◽  
Online Survey ◽  
Influential Factors ◽  
System Level ◽  
Practice Environment ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Practices

Background: In Aotearoa/New Zealand, the first nation-wide coronavirus disease 2019 (COVID-19) lockdown occurred from March 23, 2020 to May 13, 2020, requiring most people to stay at home. Health services had to suddenly change how they delivered healthcare and some services were limited or postponed. This study investigated access to healthcare during this lockdown period, whether patients delayed seeking healthcare and reasons for these delays, focusing on the accessibility of primary care services. Methods: Adults (aged 18 years or older) who had contact with primary care services were invited through social media and email lists to participate in an online survey (n = 1010) and 38 people were recruited for in-depth interviews. We thematically analysed qualitative data from the survey and interviews, reported alongside relevant descriptive survey results. Results: More than half (55%) of survey respondents delayed seeking healthcare during lockdown. Factors at a national or health system-level that could influence delay were changing public service messages, an excessive focus on COVID-19 and urgent issues, and poor service integration. Influential factors at a primary care-level were communication and outreach, use of technology, gatekeeping, staff manner and the safety of the clinical practice environment. Factors that influenced patients’ individual decisions to seek healthcare were the ability to self-manage and self-triage, consciousness of perceived pressure on health services and fear of infection. Conclusion: In future pandemic lockdowns or crises, appropriate access to primary care services can be improved by unambiguous national messages and better integration of services. Primary care practices should adopt rapid proactive outreach to patients, fostering a calm but safe clinical practice environment. More support for patients to self-manage and self-triage appropriately could benefit over-burdened health systems during lockdowns and as part of business as usual in less extraordinary times.

scholarly journals Setting the scene for paramedics in general practice: What can we expect?

2018 ◽  
Author(s):  
Kamal Mahtani ◽  
Georgette Eaton ◽  
Matthew Catterall ◽  
Alice Ridley
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Models Of Care ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Workforce ◽  
Clinical Complexity ◽  
Or Practice ◽  
General Practices ◽  
Gp Care

Primary care services in England may be reaching saturation point. Demands to see a GP or practice nurse have increased substantially. Clinical complexity has also increased; patients are living longer, but with more multimorbidity.(1) These demands are mirrored by a decline in the GP workforce, despite political pledges to reverse this.(2) New strategies are needed to tackle the current pressures in general practice and reduce the risks of harm to patients. The NHS England GP Forward View advocates investing and developing new models of care, including expansion of a multidisciplinary, integrated primary care team.(3) These recommendations reflect the findings of the Primary Care Workforce Commission, who highlighted the potential roles for clinical pharmacists, physician associates, and physiotherapists, all substituting into current GP care pathways.(4) The Commission also recommended that general practices should consider more opportunities to use the skills of paramedics in primary care. Specific roles may include running clinics, triaging and managing minor illnesses, as well as provide continuity for patients with complex health needs. Further roles may include assessment and management of requests for same-day urgent home visits, as well as regular visits to homebound patients with long-term conditions.The commision highlighted that these innovative roles should be subject to further evaluation. Nevertheless, historical and current perspectives allow us to model how the role could be fully used.

scholarly journals The experience of implementing and delivering group consultations in UK general practice

2021 ◽  
pp. BJGP.2020.0856
Author(s):  
Laura Swaithes ◽  
Zoe Paskins ◽  
Helen Duffy ◽  
Nicola Evans ◽  
Christian Mallen ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
System Level ◽  
Normalisation Process Theory ◽  
Leadership Roles ◽  
Practice Nurses ◽  
Roles And Responsibilities ◽  
Sustaining Change ◽  
Process Outcomes ◽  
Healthcare Assistant

Background: Group consultations are a relatively new concept in UK primary care and are a suggested solution to current workload pressures in general practice. However, little is known about the experience of implementing and delivering this approach from staff and organisational perspectives. Aim: To explore the experience of implementing and delivering group consultations in general practice. Design: Qualitative telephone interview study. Methods: Topic guides explored the perspectives and experiences of general practice staff on the implementation and delivery of group consultations. Data analysis adopted principles of the Framework Method underpinned by Normalisation Process Theory. Results: Interviews were conducted with 8 GPs, 8 Practice Nurses, 1 Nurse Associate, 1 Practice Pharmacist, 1 deputy Practice Manager, 1 Healthcare Assistant. Four themes were identified: sense making of group consultations; the work associated with initiating group consultations; the experiences of operationalising group consultations; and sustaining change. Group consultations made sense to participants as a mechanism to reduce burden on primary care, enhance multi-disciplinary working, and provide patient-centred care. Implementation required strong leadership from a ‘champion’, and a facilitator had a pivotal role in operationalising the approach. The associated workload was often underestimated. Barriers to embedding change included achieving whole practice buy-in, competing practice priorities, and system-level flexibility. Conclusion: General practice clinicians enjoyed group consultations, yet significant work is required to initiate and sustain the approach. An implementation plan considering leadership, roles and responsibilities and wider organisational support is required at the outset. Further research or evaluation is needed to measure process outcomes.

scholarly journals The work, education and career pathways of nurses in Australian general practice

2011 ◽  
Vol 17 (3) ◽  
pp. 227 ◽  
Author(s):  
Rhian Parker ◽  
Helen Keleher ◽  
Laura Forrest
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Career Pathways ◽  
Further Education ◽  
Educational Preparation ◽  
Practice Nurses ◽  
The Public ◽  
Career Pathway ◽  
Australian General Practice ◽  
Work Education

There is little understanding about the educational levels and career pathways of the primary care nursing workforce in Australia. This article reports on survey research conducted to examine the qualifications and educational preparation of primary care nurses in general practice, their current enrolments in education programs, and their perspectives about post-registration education. Fifty-eight practice nurses from across Australia completed the survey. Over 94% reported that they had access to educational opportunities but identified a range of barriers to undertaking further education. Although 41% of nurses said they were practising at a speciality advanced level, this correlated with the number of years they had worked in general practice rather than to any other factor, including level of education. Respondents felt a strong sense of being regarded as less important than nurses working in the acute care sector. Almost 85% of respondents reported that they did not have a career pathway in their organisation. They also felt that while the public had confidence in them, there was some way to go regarding role recognition.

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