NP's frustration at PAs getting jobs while NP services' struggle

1 November 2012

Nurse practitioners’ frustration at “millions” being found for physician assistant pilots when NP practices serving high-needs communities are closing or near broke was vented at their recent annual conference.

It was announced just before NPs gathered for the Nurse Practitioners New Zealand (NPNZ) conference in Christchurch that at least five and up to eight physician assistants (PAs) were being flown in from the United States on two-year contracts for a demonstration project in primary health.

It also coincided with news that WAVES, the NP-led youth health centre providing 5,000 free health care appointments a year in New Plymouth, had to withdraw its health service through lack of funding. A primary health NP told the conference that her NP-led rural health centre was also close to broke as it struggled without a dedicated funding stream for NP services.

Dr Michal Boyd, NPNZ chair and an aged care NP, said she found it “appalling” that funding could be found to employ US-trained PAs when established NPs serving high-needs and rural communities were “clearly struggling”.

She said NPs over the past decade had found gaps in health services and filled them but the role was “still languishing” because of a lack of policy and funding support. She said there seemed no such delays in finding funding to employ physician assistants, despite the role being unregulated in New Zealand and no education programme existing.

“When you are talking about eight physician assistants, you are talking about millions of dollars,” said Boyd. “Where is that kind of money for developing NPs?”

The NP’s frustrations bubbled up during a presentation by Paul Watson of the Ministry of Health’s Chief Nurse's Office in which he said the Government acknowledged that primary health funding streams needed to be more ‘flexible’ and work was under way to look at opening up the GMS (General Medical Subsidy) payments to non-GPs.

Professor Jenny Carryer, executive director of the College of Nurses, said the Ministry of Health had to stop patronising NPs as it had promised back in 2001 that GMS was on the way out, and more than a decade later, the GP-only funding stream was still there.

“The only thing stopping NPs [fulfilling their potential] is bureaucratic process.”

Rural NP Jane Jeffcoat was amongst the NPs who stood up to voice their frustration at a funding system still geared towards GPs. Jeffcoat, a primary health care NP funded by Waikato District Health Board to work at Taumarunui Hospital, said month after month, she was providing non-urgent primary health services for free to patients while their GPs also received capitation funding to care for them.

“At the same time, there are NPs out there not getting funding as they aren’t doctors.”

Carryer said her frustration at the PA trial was not the role itself but the Government’s failure to invest in the existing NP role, which, unlike the limited PA role, can prescribe and practise without supervision and work easily across primary and secondary boundaries.

“I am deeply angry at the immense amount of money and policy work invested to allow [PAs] to be trialled,” said Carryer. She applauded the courage of those NPs enrolling their own patients and fighting to get funding support.

“It just beggars belief that there are NPs who can’t get jobs, but we can fly PAs in at great expense,” said Angela Bates, a family health NP from Wellington’s Te Aro Health Centre.

Bates and Te Aro trustee Jill Wilkinson told the conference how the inner city practice continued to serve its homeless and high-needs clients last year despite struggles to financially survive after losing their GP. It operated as an NP-led service for eight months, leading to a dispute with their primary health organisation, which only ended with the appointment of a new GP.

Rosemary Minto, an NP working in a general practice and president of the NZNO College of Primary Health Care Nurses, acknowledged the frustration but said also there were many general practices doing positive work and growing numbers of general practitioners and managers who recognised that models needed to change. She said the Ministry of Health’s denial around funding issues did not help that change process, and with the PA pilot a reality, NPs would have to highlight the differences between the roles and carry out research providing evidence of the impact of NP services.

Hillary Graham Smith, NZNO’s associate professional services manager, also expressed dismay that continuous funding for innovative wrap-around services like WAVES was an ongoing problem despite meeting hard-to-reach populations and government initiatives for youth health.