Comments on: Train more NPs not GPs says nurse leader

By: Pat Mitchell

Tue, 19 Sep 2017 00:47:56 +0000

Kia ora Jenny and thank you for this opinion piece. As you know, Maria Kekus and I are big advocates of Nurse Practitioners and pleased to see the growth of NPs in NZ. We actively support NP training and the NP pathway.

We had the opportunity to reflect on the debate about training/educating more NPs over GPs and whilst we see there is an opportunity to growing more NPs, we know the value of GPs and having a shared approach based on our experience as a nurse-led independent business.

One area we think is often excluded in the Health Workforce debate is that of the role of non-regulated health workforce and the important role they hold.
Whether we educate more NPs or GPs – we have to acknowledge that in our experience young people coming to see a GP or NP may have brushed up against a non-regulated health worker beforehand. We would also suggest those young people who do not cross the threshold of either an NP or GP are more likely to have come in contact with a non-regulated health worker.

The Health Workforce and its future is a good debate for us to be having which includes the whole of the health workforce is essential. – how we better improve what we deliver, by who and where to achieve better outcomes for communities is key.

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By: Jenny Carryer

Tue, 08 Aug 2017 04:47:29 +0000

HI Phillip Your support and interest in NPs is valued but some of your knowledge about NPs in NZ is a little out of date. It is true that early NPs in NZ were authorised in more defined specialist areas but of the nearly 300 NPs in NZ now, and at last count, approximately half have primary health care as their scope of practice. It is the area of most rapid growth and has been for a while. They are working well in general practice settings functioning independently to the extent of owning their own business or working as partners and sometimes as locums or practice employees. No-one should work in isolation and collaboration is essential for all clinicians but they are demonstrating that they are able to deal appropriately with patients in that setting without supervision and handling the same case load on the same basis. We know that nurses are in every community in NZ, already resident and the limited evidence available shows as you suggest that they stay put because of commitments to partners and children (indeed rightly or wrongly!!). This makes them a vital resource to educate to NP level as they remain in their own community but can provide a much needed level of service. There are many rural areas where RNs with PRIME training and using standing orders are doing 24/7 call and are the backbone of that service. Becoming NPs means they will be able to prescribe independently, have an even greater level of knowledge and be a little more appropriately remunerated for what they do. And a final point. NPs are not too expensive to employ. They are able to enrol patients, claim capitation, GMS and use the flexible funding pool and fee for service as do GPs. They are therefore income generating.
This is a vital dialogue as we look to resolve the issue of service sustainability into the future.

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By: PhilipJH

Fri, 04 Aug 2017 11:27:28 +0000

Although, there is much scope for NPs in NZ, I would very much doubt if they provide even one twentieth the scope or function of any GP that I have met. In addition, what makes you think NPs are any more likely to live in rural areas than GPs? In reality, they are more likely to have restrictions caused by their family role, their children schooling and social life and, dare I say it, their spouses occupation. These are the same for all individuals and not really discipline related but may more affect women than men (rightly or wrongly). Individuals must also address the limited social life, social isolation, educational opportunities for children and access to a range of consumables that many such urban individuals take for granted. This is inevitably more problematic for all who train in the city and who may have come from urban environments (the majority). Rural medicine (RM) is indeed very rewarding but a challenging primary care environment with greater demands that even urban GPs need to adapt to. The scope of RM is definitely wider, has more limited primary and secondary support and the ‘on call’ far more daunting. One cannot cherry pick. Being a 9 – 5 NP in COPD, Diabetes, Elderly Care – those NPs one mostly have contact with – certainly don’t have a scope remotely comparable to a GP. As for NPs whose scope is primary care, these are still extremely rare and in my experience could never work in isolation – at least for many years in the post – and, in any case are quite expensive to employ considering patients will not pay such consult fees. One day this ay change but at present this is a reality. If NPs are so motivated to work in primary care, why are they not more present in AFTER HOURS? It is here that there is a really great need for NPs dealing with the worried well and minor illnesses. This is not a denegration of their training as it is here where the (quite uncommon) risks occur. Knowing when things are not quite right requires real experience when much of the time very limited skills are needed and the risks of getting things wrong are minimal. The waste of medical expertise here in a world of diminishing ageing doctors in NZ is a travesty. If NPs could show that they could tackle such a workload (15 minutes a patient) I might be impressed. Despite these negatives, I do sincerely support the evolution of nurses to NPs by broadening there scope but cherry picking narrow spectrum specialities cannot really be seen as being a GP.

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By: Zoo

Sat, 29 Jul 2017 13:21:57 +0000

If the ‘scope of service’ is the same, and ‘completely safe’, perhaps a good entry requirement for a NP would be to sit the GPEP clinical and written exam?

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By: Jenny Carryer

Sat, 29 Jul 2017 03:07:56 +0000

Thanks for your comment and yes it is indeed..yet again!!!
It is really helpful for me to understand exactly how the situation arises where you find yourself working right at the bottom of the scope, as it can be different in different places. If you feel like contacting me I would be grateful. If you look on the Massey University web site you would find my contact details Jenny Carryer

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By: Elaine Papps

Fri, 28 Jul 2017 07:48:05 +0000

Great questions, Jenny. Thank you for raising this issue. It is, after all, about access to health care.

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By: CS

Fri, 28 Jul 2017 00:42:52 +0000

Hallelujah, and thank you Jenny Carryer for talking about the obvious solution – yet again. It is beyond me why heels are being dragged on this issue either, but I might tentatively suggest that possibly it is professional jealousy from the medical profession?
In my (so far, admittedly brief) experience as a PHC nurse, many doctors still see us as little more than cleaners and ‘go-fers’, and in my current role I am working right at the bottom of my scope. Kind of sad for someone who is on a post grad pathway, hopefully leading to NP – but obviously not where I currently work.

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