A Te Herenga Waka Victoria University of Wellington researcher is calling for more funding and better use of advanced practitioners to reduce pressures on Aotearoa New Zealand’s primary health care system.
Dr Tara Officer, a postdoctoral research fellow in Te Hikuwai Rangahau Hauora Health Services Research Centre in the University’s Te Wāhanga Tātai Hauora Faculty of Health, says advanced practitioners, such as nurse practitioners and pharmacist prescribers, remain underused in New Zealand despite growing use in countries such as the United Kingdom and Canada.
Further funding to enable nurses and pharmacists to undertake postgraduate study to become advanced practitioners is needed, in particular to enable better representation in these roles from within a consumer’s community to ensure care remains close to home, says Dr Officer.
Fundamental to implementing these roles effectively is ensuring consumers and other health professionals understand the different way such practitioners operate, she says.
“The Government needs to look at how it funds postgraduate education pathways, to ensure practitioners are available and then able to be integrated into multidisciplinary teams.”
A study led by Dr Officer suggests consumers need to be involved continuously in the co-design of these roles. Its findings are expected to be of interest to the current health system reform, particularly as the reform represents another opportunity to involve consumers in shaping how health care is delivered.
“At present, we’ve got issues with increasing demand for care and limited or inappropriate distribution of resources to meet this demand. In particular, lack of continuity of care in primary health care shows us we need to make better use of our resources,” she says.
GP shortages in New Zealand have been well reported. The shortages can make access particularly difficult for consumers such as older people who benefit from an established relationship with their care providers.
Dr Officer says prescribing is one area advanced practitioners might provide additional resources to help meet this need, but the roles are not being used as much as they could.
“Nursing is the single largest regulated health care workforce—better use can be made of those working in this area.”
There is also “huge potential” for pharmacist prescribers, given pharmacy is one of the youngest health professions, says Dr Officer.
Pharmacy is often involved in care delivery external to the core team, when in fact pharmacist prescribers can be used much earlier, she says.
The study led by Dr Officer shows that involving and educating consumers is key to using these roles more effectively. Trust in the consumer’s practitioner is hugely important and this occurs when consumers feel known by their practitioner, recognise their practitioner's passion for their role, and are part of their own health care journey.
Steps are needed to involve consumers in continuous co-design, recognising their requirements for service provision will change, she says.
Consumers and other health professionals also need further education on how the advanced practitioner roles work, says Dr Officer.
“Part of that, for example, would be putting flyers in general practices to explain what these practitioners can do, in the same way we educate around health conditions.”
Patients in countries such as the UK see advantages from the roles, says Dr Officer.
“If they clearly make a difference in these countries, then we need to change how we are funding and creating the roles.”
She hopes ‘Enhancing primary health care services to improve health in Aotearoa/New Zealand’, a $4 million evaluation under way by Health Services Research Centre researchers and collaborators, will provide an opportunity to consider wider issues in service delivery and offer recommendations to improve consumer outcomes.
“The way primary health care is currently structured needs rethinking to truly incorporate patients and consumers into care decisions.”