An Introduction to Community and Primary Health Care

Introduction

A general practice nurse (GPN) provides nursing care in a primary care (general practice) setting (Halcomb, Patterson & Davidson, 2006). There are over 11 000 nurses working within general practice in Australia, with around 63.3 per cent of general practices employing at least one GPN (Australian Medicare Local Alliance, 2012). New Zealand workforce data from 2014–15 reveals that some 6.6 per cent of all nurses work in general practice, accounting for some 3317 nurses (Nursing Council of New Zealand, 2015). This places general practice as one of the five largest practice areas within the New Zealand nursing workforce (Nursing Council of New Zealand, 2015). In countries such as New Zealand and the UK, practice nursing has been well established for many years. However, in Australia it is a relatively new phenomenon. The number of nurses working in Australian general practice has exponentially expanded in recent decades (Australian Medicare Local Alliance, 2012). This has come about in response to positive government policy and financial incentives to enhance the provision of nursing services in primary care to address the growing burden of chronic and complex disease associated with population aging (Halcomb et al., 2008; Harris & Lloyd, 2012).

The general practice setting

Australian general practices are predominantly run as small businesses comprising selfemployed medical practitioners who are funded through fee-for-service payments (Merrick et al., 2012). Many practices are owned by general practitioner (GP) ‘principals’ who have the joint role of employer and clinician. The Australian health system is complex, as the federal government sets a scheduled fee for services under the Medicare payment scheme and then reimburses up to 85 per cent of the scheduled fee for the GP service (Merrick et al., 2012). Individual practices then decide whether the client will be charged an additional ‘gap’ fee. The nature of general practice operating as a business creates a significantly different environment to government-funded acute care services. While in the small business setting there is an emphasis on recouping costs for equipment and staff time, in the acute sector these resources are funded more broadly. It is vital, therefore, that GPNs understand the nature of the general practice business model and the impact that this has on service delivery.