Emily Murphy, APNA Program Solutions Officer
Melanie Irwin, Primary Times Managing Editor
Haley Hodgson is a proud Bundjalung woman who is on the path to becoming a nurse practitioner. She owns and operates Maclean Medical, on Yaegl Country, in the small town of Maclean in northern New South Wales. We caught up with Haley to hear about her nurse-led initiatives and the person-centred care she and her team provide for their community.
Haley has over 25 years of experience as a registered nurse and is a recent graduate of a Masters of Advanced Practice Nursing. When the doctor who previously owned Maclean Medical decided to retire, she decided to buy the general practice.
‘I was told I couldn’t do it, because I wasn’t a doctor,’ she says. ‘But I thought, “Why not?!”’
Maclean has a population of 2,778; however, the practice services a wide area with a population of about 30,000, including several other small towns. The area has high rates of chronic disease, and the number of local GPs has dwindled in recent years.
‘Several local GPs have retired, and we haven’t really had an influx of younger doctors into the area to replace them,’ Haley explains. ‘I think the future is going to be pointed towards nurse practitioners with GP support, as opposed to GPs with nurse support. We’re laying the foundations now for that future.’
When Haley took over the practice in 2021, her team was small, but since then it’s grown. ‘We’ve now got four GPs, a gynaecologist, a nurse practitioner, myself as a nurse practitioner in training, and a team of six nurses. I’ve had to learn pretty quickly about how to run a business!’
When asked about the high rates of chronic disease in the region, Haley lists several reasons for this.
‘Cost of living, lack of access to services, lifestyle, a larger Indigenous population,’ she says. ‘I think it’s quite indicative of rural areas in general, in comparison to regional and metropolitan areas. This is a coastal area, but it’s still very much a farming region and sometimes the rural, country mentality can stop people from seeking preventative health care. Bulk billing is no longer available here, and it can be hard to get a GP appointment. When you’ve got to come up with $100 for a doctor’s appointment, it’s not surprising that people don’t visit their GP very often, especially if they’re not actually unwell.’
Patient cohort
In 2024, Haley trialled a two-day nurse-led women’s health clinic to address health concerns among local women. Her goal was to provide preventative health care for female patients aged 40 to 65 years. The clinic was free of charge, and appointments were advertised for one week through hand-delivered letters and a post on the clinic’s Facebook page.
‘I was concerned that women in this age range often miss out on preventative health care,’ Haley explains. ‘These are middle-aged working women who are busy juggling different responsibilities, but they’re still well, at least on the surface.’
‘This is generalising, but during their child-bearing years, younger women are often having regular health checks. By the time you reach 40, it might have been several years since you last had a blood test. This is when perimenopausal symptoms can emerge; this is when chronic disease often starts. If we can check in with people early on, a lot of illnesses can be prevented, or at least delayed.’
Comprehensive care
Over a two-day period, Haley conducted one-to-one appointments with 18 local female patients. Many of these patients had not seen their GP in over a year. Drawing on Jean Hailes resources, Haley’s consultations covered general health, mental health, reproductive health, menopause, dental health, cardiovascular health and pain management.
‘I was running the clinic as a nurse, to consolidate what I’d been learning in my nurse practitioner training,’ Haley says. ‘Our senior women’s health doctor was also available on site when needed. I wanted to test how the patients would relate to the service.’
All patients reported high satisfaction with the consultations. Many said they felt more comfortable sharing issues they had previously avoided due to concerns about cost and time constraints in traditional GP appointments. In some cases, patients reported feeling more comfortable sharing health concerns with a nurse than with a GP.
‘We found that the patients opened up to us about health concerns in a way that they hadn’t done with even our female doctors,’ Haley explains. ‘I think a lot of patients view nurses as more approachable, which allows them to open up. They wanted to feel safe, and they wanted to feel listened to.’
‘It also meant a lot to them that they didn’t have to pay for that initial appointment,’ Haley says. ‘Most of them didn’t actually feel unwell. Some of them just had a hunch that they should get checked out. They were happy to pay for follow-up appointments.’
Clinic outcomes
The clinic revealed significant health issues in some patients. Several women were referred for a follow-up with their GP, including two new cases of hypertension, one new diagnosis of breast cancer, one case of renal disease, and one 40-year-old pregnant woman in her second trimester without prior prenatal care. Additionally, there were multiple menopause-related issues that required gynaecological referrals and two mental health follow-ups.
Following the clinic, Haley received the following patient feedback:
If it wasn't for Haley offering the women's health check and putting it out there as a no-charge appointment, I never would have come, and Haley would never have picked up that I had breast cancer. I am so thankful for the early diagnosis and being on the back end of my treatment now. I can only imagine how bad it could have been if this wasn't offered.
Funding challenges
Despite these positive impacts, Haley cannot sustain this model of care because it is not financially viable. She had no external funding to run the trial clinic.
‘As a nurse, I don’t get Medicare rebates, so the service didn’t bring any money in,’ she says. ‘It could be viable if there were a Medicare item number for nurses with specific training in women’s health.’
‘Even nurse practitioners are prevented sometimes from providing well-rounded care due to the current funding model,’ Haley explains. ‘For example, there are only certain scans that nurse practitioners can order that will be covered by Medicare. We can’t order mammograms, back X-rays or renal ultrasounds, unless the patient is willing and able to pay for them privately. This is a really big bugbear! These patients can’t get in to see the doctor, or they prefer to see the nurse practitioner. Many of them are hesitant to come in to begin with. We get one chance with them! If we can’t sort things out for them then and there, the likelihood that they will return is minimal. We need changes to the way care is funded so that patients are not facing unnecessary logistical hurdles.’
Haley faces similar financial challenges when it comes to providing preventative health care that is tailored for local First Nations communities.
‘We have a very big First Nations cultural community here,’ she says, ‘and we’ve been working closely with them in developing some women’s health strategies, including pre-diabetes screening. If we can catch people during the pre-diabetes phase, we can educate them, and monitor their health, and delay the onset of the illness. It’s the same for cardiovascular disease and kidney disease. If you can delay these conditions by five to ten years, that’s such a huge saving for the health system. One idea is to provide CGM monitors for Indigenous communities and to introduce this type of care with group cultural cooking events. Unfortunately, there’s currently no funding for those kinds of initiatives, especially for those of us in private practice.’
Haley continues to expand her business by building on what she has learnt and by responding to her community’s health care needs.
‘We’ve just opened an access health clinic,’ she says. ‘It’s a walk-in clinic run by our nurse practitioner and nurses. It’s open Monday to Friday for anyone who can’t get a doctor’s appointment. It’s a $50 appointment, and patients are out of pocket $25. In the last two weeks, we’ve seen nearly 500 people! We really believe that this is a new direction for health care. We’re not trying to take business away from the GPs, but we’re here as a complementary service.’
‘I’m also building a new medical centre!’ Haley says. ‘It should be ready in 2026. It will be custom built, and will have 24 consult rooms plus purpose-built nurse clinic spaces. This has been made possible by support from the community, and also thanks to the passion of my staff. My staff are very passionate too.’
We ask Haley if she has advice for other nurses who may be tempted to launch their own initiative and be their own boss.
‘It’s worth it!’ she says. ‘But it’s important that you have the right motivations. You can’t be financially motivated, because there’s no money in it! My motivation is around my link to my community and being able to do things better for my community. People will approach me in the street and say, “thank you!” and that makes all the hard work worth it. Most nurses are motivated by wanting to help people and we can make huge differences in people’s lives.’
Haley is coordinating a nurse-led diabetes clinic as a participant in APNA's Building Nurse Capacity Program. She is also a valued member of APNA's First Nations Nursing Advisory Panel, which was established to ensure that APNA’s programs are relevant and culturally safe for First Nations nurses, their employers, and other stakeholders.
To keep up with Haley and her team, go to https://macleanmedical.com.au/ or follow them on social media: https://www.facebook.com/macleanmedical.
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