The new faces of medicine

As a nurse practitioner at Fiordland Medical Centre, Claire Light can now write prescriptions, order tests and diagnostics, and see her own patients.

In the face of New Zealand's ongoing rural GP shortage, two rural Southland medical centres are counting on nurse practitioners as an integral part of their practice.

After seven years of intensive study and training, Te Anau nurse Claire Light officially became a nurse practitioner this August. This means Fiordland Medical Centre has become the second centre in the Southland District, joining Tuatapere, to count on a nurse practitioner as part of its general practice. 

The new role means she's able to offer a very similar skill set to what GPs can do, such as write prescriptions, order tests and diagnostics, and see their own patients. She effectively replaces the role of Dr Stephen Graham, who retired from the practice last year. 

While the Fiordland practice has been well-staffed for the last five to 10 years, many rural medical practices are feeling the strain of not having enough GPs to meet demand. Mrs Light said nurse practitioners working in these areas brought another prescriber to places that were struggling to attract GPs. Mrs Light specialised in primary health care, but nurse practitioners could also take on other specialisations such as mental health.

"I think in a lot of areas and towns, mental health is one that often struggles to attract GPs. Nurse practitioners have made a huge difference in those areas where, given another specialist, they can prescribe to cover some of the really, I would say, daunting and heavy patient loads that they have."

Te Anau's Dr David Hamilton said while nurse practitioners worked in a similar way to GPs, their nursing background meant they brought a different approach, providing an extra string to the bow.

"We see the gain in a bit of variety," he said.

A 2015 Royal New Zealand College of GPs workforce survey indicated that 34% of rural GPs have a permanent vacancy in their practice compared to 19% in urban areas. On top of that, around 40% of rural GPs are expected to retire in the next 10 years.

For almost a year now, Tuatapere Medical Centre has had nurse practitioner Amanda McCracken serve as its lead practitioner. She's also supported by Te Anau GPs James Macmillan Armstrong and Liz Scott, and a team of registered nurses.

Waiau Health Trust chairwoman Loralee Clarke said prior to this model, the trust had been in a constant cycle of GP recruitment, hiring overseas-trained GPs as lead practitioners. 

"A nationwide shortage of GPs was making it increasingly difficult to secure placements and ensure the community had access to a suitably qualified medical professional."

With Ms McCracken at the helm, Mrs Clarke said the trust was extremely satisfied with the current service model and how it was operating. The level of care, number of practitioner hours and wait times all stayed the same. 

"There is now a continuity of that care that wasn't always possible under the previous model."

She said nurse practitioners combined the best of nursing with skills from medicine, providing a highly skilled and highly flexible resource that could fit anywhere in the health delivery system.

"It's a fact that New Zealand doesn't have enough doctors, and rural practices are especially vulnerable. What we are doing here is innovative in addressing the issue and ensures our community have access to a suitably qualified medical professional with the ability to address their healthcare needs."

WellSouth director of nursing for primary care Wendy Findlay said there were eight nurse practitioners either working in or alongside general practice teams across West Otago, Queenstown, and Southland. 

Mrs Clarke said there were approximately 50 nurse practitioners in New Zealand in 2008. This year that number had reached around 250.

Dr Hamilton said he could see the nurse practitioner role as being helpful in closing the shortage gap across rural New Zealand.

"We'd be crazy to look past highly trained, capable people who can join our ranks."


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