Extended nursing role – a remedy for fraying health system

Nurses are significant winners in the Productivity Commission’s report on the health workforce. It recommends a bigger role for nurse practitioners and the extension of Medicare payments beyond the current monopoly of doctors.

Cautiously welcomed by a wide range of health organisations including the NSWNA, and slammed by one, the AMA, the report attempts to address the current health workforce shortages and anticipate future pressures facing the system.

The report is limited to looking at blocks in the current system that reduce efficiency and responsiveness.

Key issues such as federal funding, the use of preventative strategies to reduce health demand, an increase in education and training and initiatives to retain staff, lay outside the ambit of the study.

The Commission’s key recommendations are to:

  • extend Medicare payments beyond doctors to other health professionals including some categories of nurses and midwives
  • extend the role of nurse practitioners
  • create a health workforce improvement agency to establish new roles for health workers and facilitate the spread of local innovations nationally
  • create a single national accreditation board for health education and training.

NSWNA General Secretary, Brett Holmes, said that despite the limitations in its scope the report was a watershed document that, if implemented in an honest and transparent way, could significantly improve the delivery of health care services across Australia.

‘There will always be professional boundaries and these are essential to the maintenance of safe, high-quality health services.

However, to make sure we get the best out of the workforce it is essential that those boundaries be based on evidence, not scare mongering or professional “patch protection”,’ he said.

‘The introduction of nurse practitioners is an excellent example of how such an approach works for the benefit of everyone. It ensures skilled workers are fully utilised, without them overstepping their capability.’

One of the Commission’s key recommendations is to extend Medicare payments beyond doctors. Patients would be able to bypass their GP and go straight to the relevant health worker for a Medicare-funded consultation.

‘The extension of Medicare rebates to a wider range of health professionals will ensure we get the best out of the health workforce. This is a long overdue change,’ said Brett Holmes.

The Commission recognised the need to train more health workers and to improve the retention and re-entry to the workforce of qualified health workers – policy positions that have been strongly advocated by the NSWNA for many years.

One of the Commission’s most important and innovative recommendations was to create an agency that would establish new roles in the health workforce to ease pressures on the health system.

Key points in the report

  1. extend Medicare payments beyond doctors to other health professionals including some categories of nurses and midwives
  2. extend the role of nurse practitioners
  3. create a health workforce improvement agency to establish new roles for health workers and facilitate the spread of local innovations nationally
  4. create a single national accreditation board for health, education and training.

A snapshot of our health system

As it stands

  • expenditure on health care is 9.7% of GDP and growing
  • $78 billion was spent on health care in Australia in 2003-2004
  • there are around 450,000 paid health professionals in Australia – more than half are nurses
  • there are another 200,000 administrative and service workers employed in the health sector
  • expenditure on the workforce accounts for two thirds of total health care spending.

Future challenges
The Commission identified a number of trends that are expected to intensify the pressures on the health system including:

  • rising incomes will increase public expectations of access to high-quality health services
  • a change in the mix of disease bur-dens with a decline in the proportion of stroke victims and an increase in type 2 diabetes and dementia
  • technological change acting as a driver for growing demand and expenditure on health care
  • a change in Australia’s age profile significantly increasing health expenditure
  • an increase in the average age of health workers.

The Commission estimates that these pressures will see health costs swell to 16% of GDP by 2045.