Privately practising Nurse Practitioners remain an untapped resource for meeting Australia’s escalating health care demand, research shows.

University of Sydney lecturer Jane Currie, a nurse practitioner who has worked in the field of emergency nursing in both Australia and the UK, says her PhD research shows privately practising nurse practitioner (PPNP) services are increasing patient access to community and primary health care but more needs to be done to enable private practice NPs to fulfil their potential.

“PPNPs are an untapped resource in addressing burgeoning health care demand, particularly in community and primary health care settings,” she says.

“These are very early data as the legal changes enabling eligibility for nurse practitioners to provide services subsidised through the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS) occurred only six years ago and, like any service, it takes time to become established and to develop.

“Prior to the 2010 legislation, NPs were able to work privately, however patients were unable to obtain MBS subsidy for NP services and therefore paid the full cost of the consultation.

“If these results show anything, they show that nurse practitioners’ eligibility to provide services through the MBS and the PBS has enabled them to provide care to areas of the community that have previously been challenging to reach.”

While numerous studies have showcased the flourishing role of nurse practitioners in the public setting, this pioneering evaluation study is one of the first to examine the nation’s PPNP workforce.

The study, a survey of nurse practitioners followed up by interviews with participants, reveals almost three quarters of PPNPs are working in community-based roles, where they provide chronic and complex care services, and in primary health care services.

The study, published in the Journal of the American Association of Nurse Practitioners, shows more than a third, or 38 per cent, are working in rural and remote settings, a quarter practice in both private and public health care, while the largest age group of PPNPs is 50 years and over.

It shows PPNP services are provided both within and outside of business hours and at weekends, enabling patients to access care when fewer health services are traditionally available.

Ms Currie says it’s encouraging to see that legislative changes in 2010, which enabled nurse practitioners to access reimbursement for care delivered through the MBS and the PBS, have led to increased patient access to community-based health care services, particularly for under-serviced populations, such as the homeless, mental health and women’s health.

“That really is exciting to think that the legislation has facilitated nurse practitioners to provide services to underserved areas of the community, which was the initial intent of the nurse practitioner role,” she says.

But Ms Currie says her survey of 73 nurse practitioners, working in every state and territory across Australia except for the Northern Territory, outlined several restraints to the PPNP role, including limitations to the MBS items able to be initiated by nurse practitioners.

PPNPs can now provide services and be reimbursed through four MBS item numbers - all characterised by their length of patient consultation.

“One of the challenges for the NPs providing care subsidised through the MBS is that they are only able to access a limited number of items for pathology and diagnostic imaging and this has limited their true potential," Ms Currie says.

“For example, in caring for a patient that requires a referral for an investigation that’s not available to nurse practitioners through the MBS, the NP would need to consider an alternative approach to ensure the patient still receives the care they require.

“This might be to refer the patient back to their GP and then request that the GP then refer the patient for that investigation through the MBS. So, we’re learning that there are limitations to the MBS.

“It might be the case in the near future that the NP MBS items are reviewed in order to further facilitate what we know is a role with great potential to improve access to health care for people, across our communities.”

Since the first nurse practitioner was authorised in Australia in 2001, there are now more than 1400 registered nurses endorsed as nurse practitioners. While it is unclear how many NPs are employed in public or private health care services, nurse practitioners are working in settings ranging from community health centres to GP clinics, residential aged care facilities, hospitals, prisons, schools and universities, pharmacies and in private homes.

As highly educated, skilled and experienced registered nurses, nurse practitioners can prescribe medications, request and interpret X-rays and blood tests, diagnose health conditions, as well as refer to medical specialists.

Ms Currie, who has also published a paper on the collaborative arrangements of PPNPs, says other study data presented at the Australian College of Nursing conference recently shows 96 per cent of survey participants report undertaking direct patient care as part of their role, more than 50 per cent see up to 15 patients a day, while 80 per cent treat their patients on a regular basis.

“We know that 81 per cent interact with the public health care system and the majority of that interaction is patient referrals to health specialists - so there’s lots of potential there to improve access to care which is excellent,” she says.

Ms Currie is now working on a paper examining PPNP access to the MBS and PBS and another on PPNP practice activities.

“Already it’s very easy to see that this is only one piece of the puzzle - that there is more work that will need to be done in terms of understanding the broader impact of the role and to capitalise on the untapped potential of PPNP services in meeting the ever increasing demand for health care in Australia.”