Practice nurses increase GP short consultations

The increased role of nurses in general practice is the primary driver of recent increases in short GP consultations, a general practice researcher from the School of Public Health says.

Associate Professor Helena Britt from the University of Sydney's Family Medicine Research Centre commented on trends in GP consultation claims from Medicare in the Medical Journal of Australia today. Her comments respond to an MJA paper concluding a "dramatic" decline in long consultations by GPs in Australia - in tandem with an increase in claims for short consultations - was counter to health policy objectives and detrimental to the provision of preventive care and chronic disease management.

"The increase in shorter consultations since 2003-04 is largely due to the introduction of practice nurse item numbers to the Medicare Benefits Schedule (MBS) in 2004, which led to greater use of nurses in general practices," she says.

It doesn't mean those with chronic illnesses are being given the short shift by their doctors. The increase in short consultations seems to be the result of the GPs seeing the patient to assess what needs to be done, and (where no other actions are required) passing the patient on to the practice nurse for straightforward procedures, such as dressings, vaccinations and ear syringing. As the population-to-GP ratio is going up, this sharing of care would seem a more efficient use of health funds and doctors, and is not a bad thing.

However, in the 2010 Federal Budget the Government announced plans to change the funding structure for practice nurses in 2012, and contribute to their salaries at a set rate, rather than have claims made through Medicare for only some of their activities. The effect of this on future claims for short consultations will depend on how GPs react to this change; will this result in more or less reliance on practice nurses by GPs? Whichever way it goes, it is sure to influence the future claim rates for short consultations in general practice, one way or the other.

"The assertion made by colleagues that reliance on MBS special items has forced a reduction in consultation times is not supported by our research," Associate Professor Britt says.

In their analysis of general practice consultations, Associate Professor Britt and colleagues compared the content of short consultations 2003-2004 (before the introduction of practice nurse item numbers to Medicare) with those in 2008-2009. She used data from the BEACH program, a continuous national study of general practice activity conducted by the Centre since early 1998.