AMA’s Position Statement on nurses in general practice

Earlier this week the Australian Medical Association (AMA) published a position statement on nurses in general practice – General Practice Nurse Position Statement 2005. Revised 2015 (see here). This document is a revision of the original statement which was published 10 years ago.

This position statement came as a surprise to APNA, and as the peak professional body representing nurses working in primary health care including general practice it is disappointing we were not consulted in this process. Karen Booth, our President, has now written to the AMA’s President to express our concern around this.

While there are some positive statements about nurses contained in the position statement, it also contains a number of inaccuracies, such as outdated nurse data and a misunderstanding around nurse scope of practice. We have provided this feedback to the AMA and we hope the position statement will be amended.

It is important the role of the primary health care nurse working in general practice is clearly understood by fellow health professionals. Your experience, unfortunately, tells us that this is not the case – in the last APNA salary and conditions survey you told us that only 23% of GPs had a full understanding of nurse scope of practice in general practice and, more worryingly, 4% of GPs had no understanding of scope whatsoever. This lack of understanding is one of the many barriers faced by nurses working in the general practice setting.

Does the AMA’s position statement just add to this lack of understanding? What does the profession need in order to change attitudes and perceptions? Let us know your thoughts.

4 thoughts on “AMA’s Position Statement on nurses in general practice

  1. I am very disturbed that the AMA can put out a position statement which includes:

    ‘It is the role of the appropriate professional nursing bodies to develop and oversee education, training and continuing professional development of GPNs in consultation with general practice. In this context it is the role of the Royal Australian College of General Practitioners to work with the appropriate professional nursing body to represent general practice in the development of relevant curriculum.’

    without actually consulting with the peak body for practice nurses.

    I am also concerned that there seems to be little evidence of a significant grasp of the different qualifications and skills of nurses working in general practice as it relates to registration standards, delegation and accountability.

    In my experience the work done by practice nurses contributes of a significant amount of practice income yet our pay does not often reflect this, not to mention the generous Practice Nurse Incentive Payments.
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  2. The AMA at its best – arrogant and patronising.
    Thou shalt not:
    1. Diagnose- we can diagnose and sometimes we do it better than GP’s (Strong M, Green A, Goyder E, et al, 2014)
    2. Refer patients to specialists – we refer patients to GP’s from independent nurse led clinics- are they not counted as specialists.
    3. Independent ordering of pathology – Pap smears taken by nurses in general practice are processed under the nurse’s name (Vic cytology) and what’s more we have a better endo-cervical collection rate than GP’s (VCS, 2014).
    4. Prescribe medication – nurse immunisers independently decide what vaccinations on the schedule are due and administer – what’s more doctors often ask for help with developing catch up schedules.
    Where is the evidence for the AMA position statement surely necessary to show why one profession has the right to attempt to constrain the scope of practice of another – I see only one undated reference in the AMA statement.

    Strong M, Green A, Goyder E, et al. Accuracy of diagnosis and classification of
    COPD in primary and specialist nurse-led respiratory care in Rotherham UK: a cross
    sectional study. Prim Care Respir J 2014;23(1):67-73.
    http://dx.doi.org/10.4104/pcrj.2014. 00005
    Victorian Cervical Cytology Registry (2014). Evaluation of Cervical Screening tests Collected by Nurses in Victoria During 2014 VCCR Melbourne.
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  3. I studied for many years to be endorsed as a Nurse Practitioner in General Practice for just this reason.
    This myopic view of the nursing profession and our contribution to general practice and primary health care is staggering.
    It’s damaging to our speciality within nursing, and also to the many GPs who support our efforts. The community are denied holistic care by limiting the opportunity to engage the nursing profession in their care and the cost of this to the taxpayer and the wider health budget is enormous.
    In no other part of our profession are nurses under medical governance. Nurses in General Practice need governance by nurses for nurses.
    Unfortunately for as long as General Practice in Australia is government funded small business, we will never be heard.
    We urgently need major reform in General Practice …..may be its time for our own ‘statement on the position of GPs in General Practice’?? I wouldn’t think we would be so unprofessional as to not consult with the AMA before doing so…….
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  4. Thank you for your insightful comments, Fiona, Tracy and Wendy.

    It is unfortunate the AMA’s Position Statement appears not to recognise the true scope of primary health care nurses working in general practice. It is also unfortunate other sectors of the health profession fail to appreciate the critical contribution that nurses make in this workplace setting.

    In answer to Wendy’s comment, APNA is currently looking at developing a range of Position Statements, including statements regarding the role of primary health care nurses in general practice, as well as the role of Nurse Practitioners. It goes without saying that we will consult with relevant bodies (as well as APNA members) as part of this process.

    Thanks again.

    Simon Howe
    Policy Adviser, APNA
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