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Following the funding trail: financing, nurses and teamwork in Australian general practice.

Pearce C, Phillips C, Hall S, Sibbald B, Porritt J, Yates R, Dwan K, Kljakovic M - BMC Health Serv Res (2011)

Bottom Line: Yet the influence of the funding was to focus nurse activity on areas that they perceived were peripheral to their roles within the practice.Interprofessional relationships and organisational climate in general practices are highly influential in terms of nursing role and the ability of practices to respond to and utilise funding mechanisms.These factors need to be considered, and the development of optimal teamwork supported in the design and implementation of further initiatives that financially support nursing in general practice.

View Article: PubMed Central - HTML - PubMed

Affiliation: Melbourne East General Practice Network, Blackburn, Victoria, Australia. drchrispearce@mac.com

ABSTRACT

Background: Across the globe the emphasis on roles and responsibilities of primary care teams is under scrutiny. This paper begins with a review of general practice financing in Australia, and how nurses are currently funded. We then examine the influence on funding structures on the role of the nurse. We set out three dilemmas for policy-makers in this area: lack of an evidence base for incentives, possible untoward impacts on interdisciplinary functioning, and the substitution/enhancement debate.

Methods: This three year, multimethod study undertook rapid appraisal of 25 general practices and year-long studies in seven practices where a change was introduced to the role of the nurse. Data collected included interviews with nurses (n = 36), doctors (n = 24), and managers (n = 22), structured observation of the practice nurse (51 hours of observation), and detailed case studies of the change process in the seven year-long studies.

Results: Despite specific fee-for-service funding being available, only 6% of nurse activities generated such a fee. Yet the influence of the funding was to focus nurse activity on areas that they perceived were peripheral to their roles within the practice.

Conclusions: Interprofessional relationships and organisational climate in general practices are highly influential in terms of nursing role and the ability of practices to respond to and utilise funding mechanisms. These factors need to be considered, and the development of optimal teamwork supported in the design and implementation of further initiatives that financially support nursing in general practice.

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Organisational factors: Grid of responsibility delegation and skill set for nurses.
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Figure 1: Organisational factors: Grid of responsibility delegation and skill set for nurses.

Mentions: The capacity for different funding models to affect the clinical roles of nurses is moderated by the climate of the general practice. Thus, some hierarchical practices found that they were unable to capitalise on the enhanced skillset of the nurse, because they continued to provide little opportunity for the nurse to have autonomy within the team. The influence of organisational climate on utilisation of funding streams is represented schematically in Figure 1.


Following the funding trail: financing, nurses and teamwork in Australian general practice.

Pearce C, Phillips C, Hall S, Sibbald B, Porritt J, Yates R, Dwan K, Kljakovic M - BMC Health Serv Res (2011)

Organisational factors: Grid of responsibility delegation and skill set for nurses.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3050696&req=5

Figure 1: Organisational factors: Grid of responsibility delegation and skill set for nurses.
Mentions: The capacity for different funding models to affect the clinical roles of nurses is moderated by the climate of the general practice. Thus, some hierarchical practices found that they were unable to capitalise on the enhanced skillset of the nurse, because they continued to provide little opportunity for the nurse to have autonomy within the team. The influence of organisational climate on utilisation of funding streams is represented schematically in Figure 1.

Bottom Line: Yet the influence of the funding was to focus nurse activity on areas that they perceived were peripheral to their roles within the practice.Interprofessional relationships and organisational climate in general practices are highly influential in terms of nursing role and the ability of practices to respond to and utilise funding mechanisms.These factors need to be considered, and the development of optimal teamwork supported in the design and implementation of further initiatives that financially support nursing in general practice.

View Article: PubMed Central - HTML - PubMed

Affiliation: Melbourne East General Practice Network, Blackburn, Victoria, Australia. drchrispearce@mac.com

ABSTRACT

Background: Across the globe the emphasis on roles and responsibilities of primary care teams is under scrutiny. This paper begins with a review of general practice financing in Australia, and how nurses are currently funded. We then examine the influence on funding structures on the role of the nurse. We set out three dilemmas for policy-makers in this area: lack of an evidence base for incentives, possible untoward impacts on interdisciplinary functioning, and the substitution/enhancement debate.

Methods: This three year, multimethod study undertook rapid appraisal of 25 general practices and year-long studies in seven practices where a change was introduced to the role of the nurse. Data collected included interviews with nurses (n = 36), doctors (n = 24), and managers (n = 22), structured observation of the practice nurse (51 hours of observation), and detailed case studies of the change process in the seven year-long studies.

Results: Despite specific fee-for-service funding being available, only 6% of nurse activities generated such a fee. Yet the influence of the funding was to focus nurse activity on areas that they perceived were peripheral to their roles within the practice.

Conclusions: Interprofessional relationships and organisational climate in general practices are highly influential in terms of nursing role and the ability of practices to respond to and utilise funding mechanisms. These factors need to be considered, and the development of optimal teamwork supported in the design and implementation of further initiatives that financially support nursing in general practice.

Show MeSH