Introduction of the first practice nurse into a long term existing practice

This project required BHC to convince a solo principal to employ his very first nurse into the practice. He had been in General Practice for over 25 years and at the time of our involvement had 4 practitioners within his practice. He had argued with colleagues & the local Division of General Practice (of which he was a board member) for sometime against the benefits of a practice nurse. The challenge would be to deliver a sound argument capable of changing long held views.

As a first step BHC provided an outline of the four different nursing roles as defined by the ADGP.  Those roles are:

  1. The Clinical Support Role

  2. The Administrative/Management Role

  3. The EPC/PIP Role

  4. The Enhanced or Primary Care Role

In addition to the roles outlined above we identified a group of services that can be performed by RN’s, they include:

  • Patient monitoring and clinical management

  • Health screening and health promotion services

  • Input into chronic disease management programs

  • Home visits ECG’s, immunisations and wound care.

  • Occupational Health & Safety responsibilities

  • Infection and sterilisation control

  • Ongoing staff education programs of staff

  • Accreditation preparation

BHC identified the following suite of problems the practice faced:

  • The Practice had employed a casual Registered Nurse at $40.00 per hour on an “as needed” basis solely to perform over 75 years of age health assessments.

  • A diabetes trained Registered Nurse was being employed through the Division of General Practice on a 6 monthly basis to run (on-site) diabetic clinics.  At a cost of $50.00 per hour, the cost of engaging this service was more than double the payable rate under the award at the time. (Practice staff were still responsible for recalls, mail outs, making of appointments and co-ordination of the clinics)

  • Reception staff were trying to perform nursing duties as well as reception duties. This confusion of roles was causing considerable disruption at the front desk and also presented significant medico-legal implications.

  • Doctors were unable to meet the ever increasing demand of patient appointments

  • Doctors were working a significant number of hours beyond their normal consulting times to try to meet the demand

  • Patients were forced to wait an unacceptable period of time for appointments

  • Patients were frequently required to wait for extended periods beyond their pre-arranged appointment time. This seemed to be the accepted “norm”, whereas in fact should be the “exception”.

The new practice nurse item numbers had recently been introduced by the government which meant if nurses saw patients on behalf of a doctor for certain procedures (e.g. immunisation), there was now a chargeable item under Medicare.

The proposal BHC put forward highlighted this and showed that nursing staff could certainly generate a revenue stream into the practice. For instance at that time, the monetary difference between a patient being seen for a consult/immunisation by a doctor only,  as opposed to being seen by the nurse first then the doctor was $16.35.

However, more importantly, our proposal demonstrated the total amount of hours per day of GP time freed up equated to approximately 5.5 hours per day.

This extra time could be utilised to allow GP’s:

  • To see extra patients (therefore generating further income-at the time this had the potential to increase total GP daily income by over $1300.00 or

  • To utilise as catch up/free time or report writing etc. or

  • To utilise to increase / expand their corporate medicine.

Statistics provided in the proposal included:

  • Patient practice statistics i.e.: number of patients over 75 yrs. (annual number of Item 702’s),

  • number of patients over 65 yrs. (annual number of patients for flu vaccine – Item 10996),

  • number of patients under 5 yrs. (childhood immunisations – Item 10996) etc

BHC also demonstrated how utilising a Practice Nurse to full capacity (e.g. seeing new patients and taking history) could free even more GP time. The proposal identified achievable monthly targets that could be set as realistic KPI’s for nursing staff.

In summary, BHC’s proposal demonstrated how through employing the right practice nurse the business will:

  • Increase patient access to primary care services,

  • Enhance the range of services available to people attending the practice,

  • Provide collegiate support and assistance to the doctors,

  • Enhance the management of people with chronic conditions,

  • Support, influence and manage change,

  • Promote safety and quality programs and practices,

  • Encourage a team approach to care,

  • Decrease waiting times for appointments,

  • Decrease waiting times for consultation,

  • Increase patient satisfaction,

  • Higher regard in community for the name of the practice,

  • Decrease overload on GP’s,

  • Provide an inducement to recruit new GP’s

  • Increase turnover and profitability.

Project Outcome:

The GP’s practice started with one part-time practice nurse at 3 days per week, and then employed a second nurse approximately 12 months later to job share so the position was covered on a full time basis. He currently employs 3 RNs and often comments “he doesn’t know how he ever coped without a nurse before!”

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