A country practice: the nurse practitioner-led clinic helping to close the rural health care gap 

20 December 2019

In a State-first, a nurse practitioner-led clinic is making it easier for rural residents to access health care in the face of an ongoing medical workforce shortage.

“We have long had difficulties recruiting General Practitioners in Pinnaroo, as every small town does, and I wanted to find a way for Nurse Practitioners to be able to help,” says clinic founder Di Thornton.

After four decades of working as a Registered Nurse and Midwife, including at management and executive level, Di completed her studies to become a Nurse Practitioner in 2012. Months of red tape later, she established her own clinic in the Murray Mallee region.

“We have a physio working 2 days per week, a podiatrist 2 days per fortnight, and a mental health worker who comes down here once a fortnight. We have a masseuse twice a week, and a diabetes educator who comes down regularly. It’s a one-stop shop for people’s health needs in a small country area.”

“People sign that they are happy for all of our practitioners to share notes, so if I have someone who comes in with lower back pain, I can easily refer to our physiotherapist and podiatrist when indicated and they are able to help.”

The multidisciplinary model has drawn support from surrounding general practitioners, including the one Di employs to cover the more complex cases that are beyond her scope of practice.

“There are things I can’t do, such as mental health plans and investigations, so I contracted with the Loxton Medical Centre to supply me a GP one day a week in Pinnaroo and once a month over the Victorian border in Murrayville.”

She says the days of having solo health practitioners working alone have gone.

“It doesn’t matter if people work part-time, you need that team environment. What we have here has proven to be a very robust model for continuity and completeness of care.”

She says patronage is growing phenomenally for a clinic accessible to a population of around 1,500 people in proximity to Pinnaroo and small towns over the border.

“We are busy, and we are getting busier—we’ve just registered our 1,349th patient. Our patients tell us all the time how grateful they are to have such ready access to this health care option.”

For a model of care making a difference for so many people, there seems to be only one disadvantage—but to many health practitioners it is a showstopper.

“The financial side of it has to change,” Di says. “The numerous Medicare Benefits Schedule (MBS) restrictions significantly limit the ability of any Nurse Practitioner to make a living out of working this way.”

“I’ve only just started paying myself after nearly two years in the clinic, but I’m not earning anywhere near what I could be earning if I left private practice.”

She estimates about 20 per cent of her caseload is limited by MBS restrictions.

“We can order an ultrasound of the leg or the hip, but we can’t order the cortisone if the patient has bursitis, and that just fragments care.”

“To get around that, if there’s someone I believe may have bursitis, I ask the GP to countersign the ultrasound request with plus/minus cortisone.”

She says taking time off is also problematic.

“If you’re in a country GP practice, there is lots of funding for locums to come in, but there is no such thing for Nurse Practitioners. I took two weeks off last year and it ended up costing me $8,000 to pay for the travelling and coverage costs for someone to replace me.”

With the support of the Australian Nursing and Midwifery Federation (ANMF), Di hopes many of these restrictions will change following the current MBS review.

The MBS Review Taskforce is reviewing more than 5,700 MBS items—including Nurse Practitioner MBS items—and considering how services can be better aligned with contemporary clinical evidence and practice to improve outcomes for patients.

“The ANMF has conveyed to the Taskforce its full support for the removal of key restrictions that currently preclude Nurse Practitioners from establishing financially viable models of care within their scope of practice,” says ANMF (SA Branch) CEO/Secretary Adj Associate Professor Elizabeth Dabars AM.

“With a growing shortage of medical practitioners in rural areas, we need a system that incentivises and supports Nurse Practitioners like Di to provide regional residents with convenient access to safe and appropriate health care,”
Ms Dabars says.

“We soon hope to see long-overdue changes to the MBS that support Nurse Practitioners working to their full scope of practice in this way, increasing their contribution to integrated, efficient health care for the community.”
The Taskforce is expected to finalise

its recommendations to Government later this year.