The influence of funding models on collaboration in Australian general practice
Susan McInnes A D , Kath Peters B , Andrew Bonney C and Elizabeth Halcomb A
+ Author Affiliations
- Author Affiliations
A School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
B School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
C School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
D Corresponding author. Email: sm341@uowmail.edu.au
Australian Journal of Primary Health 23(1) 31-36 https://doi.org/10.1071/PY16017
Submitted: 14 February 2016 Accepted: 23 April 2016 Published: 25 July 2016
Abstract
Despite more nurses working in Australian general practice, there has been limited investigation exploring ways that general practitioners and registered nurses work together to deliver clinical care. However, it has been postulated that the small business structure, common in Australian general practices, might influence collaboration between these two groups of health professionals. This paper presents one theme from a larger qualitative study. Eight general practitioners and fourteen registered nurses working in general practice participated in semistructured face-to-face interviews between February and May 2015. Naturalistic inquiry was adopted to elicit and explore the narrative accounts of participants about working together in general practice. An inductive process of thematic analysis was used to identify, analyse and report patterns and themes. Ancillary costs associated with the employment of registered nurses in general practice and the time registered nurses took to undertake procedural services were a concern for general practitioners. Registered nurses did not always work to their full scope of practice and many felt that their expertise was not appropriately remunerated. Findings suggested that fee for service-funding models can negatively influence collaboration between general practitioners and registered nurses working in general practice.
References
Afzali H, Karnon J, Beilby J, Gray J, Holton C, Banham D (2014) Practice nurse involvement in general practice clinical care: policy and funding issues need resolution. Australian Health Review 38, 301–305.| Practice nurse involvement in general practice clinical care: policy and funding issues need resolution.Crossref | GoogleScholarGoogle Scholar | 24870661PubMed |
APNA (2014) APNA salary and conditions survey 2014. Primary Times 14, 8–9.
Barrett J, Curran V, Glynn L, Godwin M (2007) CHSRF synthesis: interprofessional collaboration and quality primary healthcare. Available at http://www.cfhi-fcass.ca/Migrated/PDF/ResearchReports/CommissionedResearch/SynthesisReport_E_rev4_FINAL.pdf [Verified 18 November 2014]
Bell K (2013) Eighteen months into the PNIP journey: how are we travelling? Primary Times 13, 2
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.
| Using thematic analysis in psychology.Crossref | GoogleScholarGoogle Scholar |
Britt H, Miller G, Henderson J, Bayram C, Harrison C, Valenti L, Wong C, Gordon J, Pollack A, Pan Y, Charles J (2015) General practice activity in Australia 2014–15. General practice series number 38. (Sydney University Press: Sydney) Available at purl.library.usyd.edu.au/sup/9781743324523 [Verified 2 August 2015]
Carlowe J (2008) Practice nurses deserve more. Nursing Times 104, 14–16.
Coleman K, Austin BT, Brach C, Wagner EH (2009) Evidence on the chronic care model in the New Millennium. Health Affairs 28, 75–85.
| Evidence on the chronic care model in the New Millennium.Crossref | GoogleScholarGoogle Scholar | 19124857PubMed |
D’Amour D, Ferrada-Videla M, San Martin Rodriguez L, Beaulieu M-D (2005) The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks. Journal of Interprofessional Care 19, 116–131.
| The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks.Crossref | GoogleScholarGoogle Scholar | 16096150PubMed |
Gillam SJ, Siriwardena AN, Steel N (2012) Pay-for-performance in the United Kingdom: impact of the quality and outcomes framework: a systematic review. Annals of Family Medicine 10, 461–468.
| Pay-for-performance in the United Kingdom: impact of the quality and outcomes framework: a systematic review.Crossref | GoogleScholarGoogle Scholar | 22966110PubMed |
Halcomb EJ, Davidson PM, Daly JP, Griffiths R, Tofler G, Yallop J (2005) Nursing in Australian general practice: directions and perspectives. Australian Health Review 29, 156
| Nursing in Australian general practice: directions and perspectives.Crossref | GoogleScholarGoogle Scholar | 15865566PubMed |
Halcomb E, Davidson P, Salamonson Y, Ollerton R, Griffiths R (2008) Nurses in Australian general practice: implications for chronic disease management. Journal of Nursing and Healthcare of Chronic Illness in Association with Journal of Clinical Nursing 17, 6–15.
Halcomb E, Salamonson Y, Davidson P, Kaur R, Young S (2014) The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on. BMC Family Practice 15, 52
| The evolution of nursing in Australian general practice: a comparative analysis of workforce surveys ten years on.Crossref | GoogleScholarGoogle Scholar | 24666420PubMed |
HSCIC (2015) Quality and Outcomes Framework (QOF): 2014-15. (Health and Social Care Information Centre) Available at http://www.hscic.gov.uk/catalogue/PUB18887 [Verified 21 January 2016]
Jacobson P (2012) ‘Evidence Synthesis for the Effectiveness of Interprofessional Teams in Primary Care.’ (Canadian Health Services Research Foundation: Ottawa, ON, Canada)
Laurant M, Reeves D, Hermens R, Braspenning J, Grol R, Sibbald B (2005) Substitution of doctors by nurses in primary care. Cochrane Database of Systematic Reviews CD001271
| Substitution of doctors by nurses in primary care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M3htFegtA%3D%3D&md5=8a3a8584fd0c52e8356288a8892241d2CAS | 15846614PubMed |
Lincoln YS, Guba EG (1985) ‘Naturalistic Inquiry.’ (Sage)
McInnes S, Peters K, Bonney A, Halcomb E (2015) An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. Journal of Advanced Nursing 71, 1973–1985.
| An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice.Crossref | GoogleScholarGoogle Scholar | 25731727PubMed |
McKenna L, Halcomb E, Lane R, Zwar N, Russell G (2015) An investigation of barriers and enablers to advanced nursing roles in Australian general practice. Collegian (Royal College of Nursing, Australia) 22, 183–189.
| An investigation of barriers and enablers to advanced nursing roles in Australian general practice.Crossref | GoogleScholarGoogle Scholar |
Medicare Australia (2016) Practice Nurse Incentive Program (PNIP). Available at https://www.humanservices.gov.au/health-professionals/services/medicare/practice-nurse-incentive-programme?utm_id=9 [Verified 18 January 2016]
New South Wales Ministry of Health (2015) Public health system nurses’ and midwives (State) award, 2015. Industrial relations commission of New South Wales. Available at http://www.health.nsw.gov.au/careers/conditions/Awards/nurses.pdf [Verified 8 January 2016]
Nursing and Midwifery Board of Australia (2006) National competency standards for the registered nurse. Available at http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Verified 18 November 2015]
OECD (2011) Health at a glance: 2011 OECD indicators. (Organization for Economic Co-operation and Development) [Verified 12 January 2016]. Available at
OECD (2013) Health at a glance: 2013 OECD indicators. (Organization for Economic Co-operation and Development) [Verified 12 January 2016]. Available at
OECD (2015a) OECD reviews of health care quality: Australia 2015: raising standards. (OECD Publishing: Paris) [Verified 12 January 2016]. Available at
OECD (2015b) Modes of payment in primary care. (Organization for Economic Co-operation and Development) Available at http://www.oecd.org/els/health-systems/paying-providers.htm [Verified 29 January 2016]
Pearce C, Phillips C, Hall S, Sibbald B, Porritt J, Yates R, Dwan K, Kljakovic M (2011) Following the funding trail: financing, nurses and teamwork in Australian general practice. BMC Health Services Research 11, 38
| Following the funding trail: financing, nurses and teamwork in Australian general practice.Crossref | GoogleScholarGoogle Scholar | 21329506PubMed |
Phillips C, Pearce C, Dwan K, Hall S, Porritt J, Yates R, Kljakovic M, Sibbald B (2008) Charting new roles for Australian general practice nurses: Abridged report of the Australian general practice nurse study. (APHCRI: Canberra) Available at http://files.aphcri.anu.edu.au/research/full_report_47129.pdf [Verified 6 November 2015]
Phillips CB, Pearce C, Hall S, Kljakovic M, Sibbald B, Dwan K, Porritt J, Yates R (2009) Enhancing care, improving quality: the six roles of the general practice nurse. The Medical Journal of Australia 191, 92–97.
Polit DF, Beck CT (2014) ‘Essentials of Nursing Research: Appraising Evidence for Nursing Practice.’ (Lippincott Williams & Wilkins: Philadelphia, PA)
Pullon S, McKinlay E, Dew K (2009) Primary health care in New Zealand: the impact of organisational factors on teamwork. The British Journal of General Practice 59, 191
| Primary health care in New Zealand: the impact of organisational factors on teamwork.Crossref | GoogleScholarGoogle Scholar | 19275835PubMed |
Putnam J, Ikeler S, Raup GH, Cantu K (2014) There’s no ‘i’ in team: evaluating nurse-physician collaboration. Nursing Management 45, 10–13.
| There’s no ‘i’ in team: evaluating nurse-physician collaboration.Crossref | GoogleScholarGoogle Scholar | 24366381PubMed |
US Department of Health and Human Services (2013) Projecting the supply and demand for primary care practitioners through 2020. Rockville, Maryland. Available at http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/primarycare/projectingprimarycare.pdf [Verified 15 December 2015]
Wagner EH (2000) The role of patient care teams in chronic disease management. British Medical Journal 320, 569–572.
| The role of patient care teams in chronic disease management.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7ltlemuw%3D%3D&md5=37e7f5ff8b1b1027a5fe128f7c1bbcecCAS | 10688568PubMed |
