New study says Oz nurses could carry some of the GP workload

An Australian National University study says Medicare needs to be restructured so patients can see practice-registered nurses at GP clinics instead of doctors for certain conditions. This they say will help relieve the chronic workforce shortage, which promises to continue until at least 2012.

They predict the crisis will only worsen with the rise in chronic diseases.

Lead author of the study, associate Professor Jill Thistlethwaite, who is also a GP at Sydney University, suggests practice nurses should be given more autonomy to see patients for minor illnesses, conduct health checks for patients with chronic diseases such as diabetes, do follow-up vaccinations and give advice on healthy lifestyles.

Dr. Thistlethwaite also says Medicare items should be restructured because in her view the main problem was that doctors would not get the payment and the situation was very much driven by a financial rather than a clinical agenda.

The Australian Medical Association's council of GPs is opposed to the idea and chairman Rod Pearce says it shifts too much responsibility from doctors.

He believes the move would be counterproductive in that time would have to be spent "overchecking" decisions made by the practice nurse adding more expense.

Unnecessary delays

Dr. Pearce says if the expertise is not upfront unnecessary delays and inefficiencies result and practice nurses, who are less qualified than nurse practitioners, were not experienced enough to see patients without doctor supervision.

The study also explored the factors affecting the career paths taken by junior doctors and medical students, and suggested policies to tackle the GP shortage.

Professor Thistlethwaite says as now 70 per cent of medical students were women, a paid maternity scheme was needed to attract and retain GPs and this could be done through salaried GP positions in community clinics or at the so-called "super clinics" promised by the Federal Government to relieve hospital emergency departments.

Professor Thistlethwaite suggests that instead of doctors' income coming directly from Medicare payments, they could be given a fixed salary and paid leave, which would attract more medical students, who were seeking a better work-life balance and wanted to work fewer hours.

General Practitioners are not paid as much as specialties.

What influences medical students, doctors?

The research showed that a number of factors when making a career choice, including work/life balance, experiences during training and at medical school, and their personality, influences medical students and doctors.

Professor Jill Thistlethwaite says making general practice flexible in training and working hours would be a big draw card for the new generation of doctors.

Incentives such as funding maternity leave or developing salaried general practice positions which give job security and regular remuneration are needed to retain women in the workforce along with greater financial support for GPs who took on medical students to encourage better training opportunities for young recruits.

Professor Nicholas Glasgow, APHCRI Foundation Director, said Professor Thistlethwaite's research is one of nine projects funded by the Institute to examine how to rectify the serious workforce shortage in primary health care in Australia.

The Australian Primary Health Care Research Institute at the ANU funded the research.

For information on Professor Thistlethwaite's research Attracting health professionals into primary health care: strategies for recruitment and others examining general practice nursing, mental health care and rural and remote health workforce issues see: http://www.anu.edu.au/aphcri/Domain/Workforce/index.php