Stories about communities hit hard by GP shortages have gained a lot of airtime in recent months. Professor Jenny Carryer argues it is time for mainstream media to open their eyes to one answer – nurse practitioners.
The last few months has seen a concerted effort by general practitioner groups to give GP workforce shortages a great deal of air time in the lead up to the election.
Various media sources have been more than willing to search out people living in rural areas who cannot access care and to highlight their plight. The story of current and worsening crisis in the availability of a doctor has received constant exposure.
For many communities, the stress and health problems exacerbated by either lack of access to GP services or the unaffordability of GP services is of serious concern. Such lack of access is frightening for people and will continue to increase the pressure on secondary services as the ambulance at the bottom of the cliff. Some sources have suggested that regardless of availability half a million New Zealanders cannot afford GP services as they are currently delivered.
During this period nursing has tried valiantly to ask the media to highlight the solution hiding in plain sight, in the form of nurse practitioners.
We have consistently provided the media with the following clear bulleted information:
- Nurse practitioners (NPs) are registered nurses with an additional master’s degree and authorised by legislation in an advanced scope of practice
- They have the same level of prescribing, diagnostic capacity and treatment delivery as a GP.
- There are already nearly 300 working in the role in New Zealand and half of those are in primary care settings.
- NPs cost a sixth as much as a GP to produce
- There are already 4000 New Zealand nurses spread all over the country who have completed that clinical master’s degree and many more in progress. Many would take up positions as NPs if positions were made available.
- Potential candidates (registered nurses) sit in every rural area and small town and all the areas currently deeply concerned for the absent or disappearing GP services.
- NPs working with registered nurses can provide a comprehensive team to service unmet need in communities. A number are already doing so across New Zealand.
These approaches have been made to TVNZ’s Seven Sharp, to RNZ’s Checkpoint and to RNZ’s health correspondent. Not one single person has bothered to engage with this information. I even asked the producer of Checkpoint (via answer phone message) to please just explain to me why this story was of no interest when recycling the GP shortage story was presumed to be of constant interest to the public. No answer was forthcoming.
There is more to this story that needs to be considered. It was recently reported in New Zealand Doctor magazine (from the Medical Schools Outcomes Database report) that the number of medical graduates intending to work in small towns and provincial cities has reduced further. They noted that few people finishing their medical training want to live and work in towns with a population under 10,000, indeed only 1.6 per cent of New Zealand graduates from 2015 saw small towns as places they wanted to practise. Only 6.4 per cent wanted to practise in the next-largest towns, such as Whakatane, Masterton and Levin, with populations between 10,000 and 25,000. The graduates from three years previously showed similar results.
Such data suggests that continuing to invest in the production of more and more medical graduates will not resolve the problem of poor access for small urban areas and for rural areas even less so. Such data tells us that a much more reliable and cost-effective model is long overdue for implementation.
Long standing international data shows that where people do receive care from a nurse practitioner that patient satisfaction is high. Furthermore, there is emerging data that NP patients feel better informed and more enabled to manage their health and their conditions. Patients report feeling more able to ask questions and more likely to understand the information when provided. NPs have been practicing in the United states for about 60 years and there is a long, very solid evidence history of patient safety and quality care; in addition to emerging evidence of the value of a different model of care.
New Zealand media are continuing to tell the story of shortage and impending crisis whilst ignoring a viable solution. They could play a highly constructive role in raising public and political awareness of this obvious solution to health service sustainability in New Zealand. At the same time this would encourage the creation of positions of employment for NPs and thus the 4000 nurses already nearly qualified, might well be encouraged to step forward.
This seems so much more useful than simply repeatedly bemoaning the GP shortages.
Recently a young refugee woman I support attended a GP for her asthma and paid $47; a huge, indeed unmanageable slice of her benefit which she cannot pay without help. Rather than ask for help again she failed to attend her GP the next time and spent five days in a public hospital.
We have to find a more affordable solution not just on vital humanitarian grounds but on a cold, hard, cost-efficacy basis.
Professor Jenny Carryer is the executive director of the College of Nurses Aotearoa and a Professor of Nursing at Massey University’s School of Nursing.