This has been a very good week for the recipients of primary health care (PHC) in Australia. However, a week where PHC gets a significant funding boost is also a good week for the recipients of secondary, tertiary and quaternary health care in Australia, as it means that the right people get the right care in the right place.
Clearly, a significant proportion of these PHC reforms address the concerns around General Practitioner (GP) remuneration and incentives for doctors to move into general practice. The $5.7 billion funding package for Medicare triples the bulk-billing incentive, increases Medicare rebates twice within the year, and also boosts the Workforce Incentive Payment. There are also funds for a new Medicare item for longer consultations lasting more than 60 minutes.
However, what is even more critical about this budget for PHC recipients is that it recognises, enhances and capitalises on the role of the more than 100,000 nurses and nurse practitioners (NPs) who are already working in PHC. The funding will also undoubtedly encourage more who hope to work in PHC. Such recognition and enhancement is critical to a more equitable approach to universal health coverage, given the fact that geographic distribution of GPs in Australia is problematic, and that nurses and NPs already fill those gaps, but to date with limited funding and support.
For nurses working in PHC, there are a number of key foundational steps to enabling better access for all to good health care. These include: funding for an 18-month national Scope of Practice review (to ensure that nurses are able to work to full scope of practice in PHC), 6,000 additional clinical placements in primary healthcare nursing ($4.2 million over four years) and $1 million towards incentives to get 500 nurses back into the workforce.
For nurse practitioners (NPs), a number of restrictions have been lifted that will enable NPs to work to full scope of practice and to be adequately remunerated for the work they do. NPs have struggled to gain a foothold in the PHC and aged care environments, despite their significant success in tertiary health care, where they have demonstrated significant improvements in care and innovation. The original intent of introducing NPs into the Australian health workforce was that they would service the underserved, but due to significant opposition from medical lobby groups in the past, this has been extremely difficult in PHC (although some NPs have gone to significant lengths to provide such services).
The three announcements of key significance to NPs were as follows: that there will be an end to the legislated Collaborative Arrangements that put patients of nurse practitioners at financial disadvantage and significantly limited NP practice, especially in PHC; that Medicare rebates for Nurse Practitioners will rise by 30%, at a cost of $46.8 million; and that 1,850 Postgraduate scholarships will enable registered nurses to become Nurse Practitioners at a cost of $50.2 million. These are critical issues to encourage our most experienced and senior clinical nurses to aspire to and afford to study for roles as NPs in the future and to make their mark in PHC, where so much more support for health care is needed.
These announcements come (fittingly) in the week in which we celebrate International Nurses Day. May 12th is Florence Nightingale’s birthday and, on this day, we pause to recognise the work of nurses everywhere. Despite the fact that Miss Nightingale is considered as the founder of modern nursing in terms of its organisation and education, in reality there have always been nurses, because there have always been people in our lives, whether personal or professional, in need of compassionate, skilled care and protection, and women (and some men) throughout the ages have provided that care.
Sarah de Gregorio, writing about the importance of also recognising the work of other pioneer nurses, such as Elizabeth Seacole, makes the point that nursing is actually radically political in its attitude to social justice and universal health care. She quotes Mark Lazenby, who stated that “Nursing is a profoundly radical profession that calls society to equality and justice, to trustworthiness and to openness. The profession is, also, radically political: it imagines a world in which the conditions necessary for health are enjoyed by all people.”
De Gregorio goes on to say:
Whether you are a nurse or not, imagine it. Imagine a world in which the conditions necessary for health are enjoyed by all people. Nurses have a unique ability to bring such a world to fruition…When we understand nursing as the skilled modern expression of a fundamental, universal and ancient human instinct, we can also understand ourselves differently: Maybe it is not inevitable that we dominate each other, organize ourselves into false hierarchies. Maybe we don’t have to live according to a cruel and distorted fantasy of survival of the fittest written into laws and policy that leave people behind.
Instead, we could organize ourselves around the very old, very powerful idea that everyone, everywhere deserves care. Maybe we were made for that.
Maybe, just maybe, this budget recognises some of that too.
Mary’s career spans 40 years both in the United Kingdom and Australia. Mary is Professor Emerita, Susan Wakil School of Nursing at the University of Sydney. In 2003/04 she was the Chief Nursing Officer, NSW Health Department and prior to that was the Foundation Professor of Nursing in Corrections Health, with the University of Technology, Sydney.
Mary is a Board member of Northern Sydney LHD and chairs their Health Care Quality Committee. She also serves on the Health Ethics Advisory Panel to the NSW Minister for Health and the Clinical Governance Advisory Committee to Healthdirect Australia.
Mary was awarded an AM for significant contributions to nursing and midwifery education and healthcare standards in June 2019.
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