Nurse clinics: Optimising community access to primary health care

By APNA Project Officer Jo Millard

Source: APNA Primary Times Summer 2022-23 (Volume 22, Issue 2)

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Australia’s experience with the COVID-19 pandemic saw its primary health care (PHC) system stretched to the limit. Stories abound of members of the community struggling to find a local GP, particularly in rural and regional areas. In this environment, surely it is time to embrace innovation and expand the adoption of nurse-delivered team-based models of care. 

We’ve all heard the stories about how difficult it has been in recent months for people to access PHC. It’s no secret that the continuing COVID-19 pandemic is stretching our health systems to the limit. 

PHC nursing is no different. Whether it’s workforce shortages, health worker burnout, general fatigue, career dissatisfaction leading to early retirement, or an aging workforce, pressures on PHC nurses have been unrelenting.  

This pressure on the PHC network has also had ramifications for the wider health system, including emergency departments being overwhelmed by avoidable hospital presentations; delays to patients accessing routine preventative screening, chronic disease management or wellbeing checks; as well as soaring demand for wellbeing and mental health support services.^{i ii iii} 

‘I didn't really have the support from the GPs. So, I thought with the help from APNA then I'd have a bit of support. I'd have help to provide the information for the GPs, and back-up to establish it. It's worked out perfectly.’  

It is time to support new approaches to care delivery via early intervention and prevention. We saw the health system respond to early COVID challenges by improving access to telehealth provision. However, with the ongoing burden of COVID, an aging population and increased numbers of people living with multiple comorbidities, we need a health reset.^iv The health system requires ongoing innovation, system revitalisation and the optimisation of health workforces, including PHC nurses working to their full scope of practice, to address system delays and impacts of the pandemic, and to improve equitable access to services. One innovative option is nurse-delivered models of care. 

As part of its work to support nurse-delivered team-based models of care (nurse clinics), APNA has undertaken several workforce programs to facilitate chronic disease risk screening, disease prevention, and management within the community.^v  

The Gippsland Primary Health Network has also initiated several projects intended to improve early risk identification, intervention, and prevention of chronic disease. In 2021, it engaged APNA to implement the ‘Supporting Establishment of Nurse Clinics for Risk Prevention Project’ in response to environmental and health challenges. APNA’s project promoted a ‘whole-of-team’ approach to establishing nurse clinics.  

APNA’s project included: 

• induction to the APNA Nurse Clinic Building Blocks to support health-care teams  
• identification of local health needs and establishment of their nurse clinics 
• nurse professional development 
• self-assessment using the Australian Advanced Practice Nursing Self-Appraisal Tool, resources, and APNA support.5 

Two early risk-identification, prevention, and screening clinics were established, with 80 patients seen between July 2021 and February 2022. Each nurse clinic saw high patient acceptance of the care provided.  

‘I've been trying to establish a nurse-led clinic in the clinic for a long time, and with no luck,’ said one lead nurse working in the nurse clinic. ‘I didn't really have the support from the GPs. So, I thought with the help from APNA then I'd have a bit of support. I'd have help to provide the information for the GPs, and back-up to establish it. It's worked out perfectly.’  

Health coaching, education, and intervention value-added to patient care: 74% of patients indicated they were at least somewhat willing to access a health coach

The benefits of nurse clinics include timely and early intervention, referral, and prevention activities, resulting in improved wellbeing and health outcomes for patients attending nurse clinics. Patient feedback has been very positive, according to the Patient Enablement and Satisfaction Survey. ‘The nurse was so kind, and I have never felt more comfortable seeing a nurse before,’ one patient said. ‘That sort of experience has now encouraged me to not be worried about making more appointments in the future and staying on top of these things.’vi 

 

Conclusions and recommendations 

The APNA nurse clinics identified patient health concerns that may otherwise have gone undetected, which resulted in timely referral. Patients were very satisfied with the care provided.  

Health coaching, education, and intervention value-added to patient care: 74% of patients indicated they were at least somewhat willing to access a health coach.^vii 

Nurse clinics can provide improved access to preventative care, particularly in rural and remote areas. Scaling up nurse clinics to improve access to early risk identification and intervention, and prevention of chronic disease could be considered, based on the project findings and previous APNA Building Nurse Capacity and nurse clinic work over many years. 

Health system innovation is necessary and possible. This should include consideration of a sustainable funding model to support the implementation of nurse clinics to meet contemporary community health needs, optimise workforce scope of practice, and improve equitable access for patients to preventative health care. 

 

References 

 

[1] LP Dawson, E Andrew, M Stephenson et al., ‘The influence of ambulance offload time on 30‐day risks of death and re‐presentation for patients with chest pain’, Med J Aust, 2022, 217(5):253–259.

[2] Australian Institute of Health and Welfare (AIHW), ‘Mental health services in Australia: mental health impact of COVID-19’, AIHW website, 26 August 2022, accessed 7 October 2022. www.aihw.gov.au

[3] Heart Foundation, ‘Fears 27,000 heart checks missed in pandemic could lead to wave of heart disease: new data’, Media release, Heart Foundation website, 26 September 2021, accessed 7 October 2022. www.heartfoundation.org.au

[4] D Itchhaporia, ‘The evolution of the quintuple aim: health equity, health outcomes, and the economy’, J Am Coll Cardiol, 2021, 78(22):2262–2264.

[5] APNA, ‘Nurse Clinics – A welcome change’, APNA website, accessed 7 October 2022. https://nurseclinics.apna.asn.au/real-nurse-clinics/

[6] APNA, ‘Nurse Clinics: Evaluation and improvement – Patient Enablement Satisfaction Survey’, APNA website, accessed 7 October 2022. https://nurseclinics.apna.asn.au/tools-and-resources/

[7] Deloitte, Digital Health Cooperative Research Centre, Consumers Health Forum of Australia and Curtin University, ‘Australia’s health reimagined: the journey to a connected and confident consumer’, Deloitte website, March 2022, accessed June 2022. www2.deloitte.com