The current health and hospital system is not adequately funded, nor are health care staff supported, to provide primary health care or health maintenance to the community.
Primary health care, through personal care and health promotion, supports the prevention of illness through community participation and development. Primary health care considers the social, economic, cultural and political determinants of health to achieve universal and equitable health care.
While the World Health Organisation promotes the concept of Primary Health Care, the Australian system seems crippled by the belief that only medical practitioners are able to provide safe care anywhere.
While nurses and midwives specialising in community care, as well as sexual health, occupational, mental, indigenous and child health are well equipped and well qualified to provide safe and competent primary health care across the state they often have limited capacity to do so.
The Nurse Practitioner role for example, which is dedicated to providing expert and innovative care in areas of need, is designed to take specialty services to where there are significant gaps in service delivery.
Nurse Practitioners are limited in their role due to current federal limitations in prescribing and referral rights. This means that patients are still forced to attend doctors clinics or hospital for rebates through the Pharmaceutical Benefits Scheme and Medicare.
In addition the Queensland government only provided funding for 40 new Nurse Practitioner positions over the next two years. This low number of places does not display a real commitment to the introduction of this valuable role, even though 81 percent of people recently surveyed support the implementation of the nurse practitioner role.
The Australian health care system is still predominately stuck in an expensive acute care model which is medically dominated and often not patient centred and which fails to ensure the basic principals of primary health care.
In 2005–06, less than 2 percent of health expenditure was for preventive services or health promotion. For that same year over 9 percent of hospital admissions were considered potentially preventable.
Nurses know that primary health care, through support and resourcing for nurse/midwife led models, will help reduce much of the pressure on our hospitals.
An acute care focused model is not only impacting on the nature of our health workforce but may also compound health workforce shortages because more acute beds are needed to keep pace with population growth and increased sickness.
Work to be done
With the current focus on health reform, it is timely to investigate new approaches to health care delivery in Australia. The need to shift focus from acute to preventative health models in particular is of great urgency.
A commitment by all levels of government to prioritise health maintenance and prevention as apposed to acute care provided under a medical model, offered by a range of health professionals may in fact reduce health workforce shortages.
In other countries nurses offer both acute care and primary health care under nursing models within the community health settings. In these countries nurses may refer to other health professionals but nurse’s co-ordinate the care of clients within the multidisciplinary team. Some of these models operate in developing countries, not as alternative model to address medical personal shortages but as the most appropriate service. Surely this is indicative of a less expensive and more appropriate service, safely managing client presentations under a nursing model of care.
New multidisciplinary care models are required in community based settings, for example, nurses practitioners working with GPs and other health professionals to provide care for those with chronic illnesses.
If we are to value the nursing input into the system there must be amendments to legislation to allow appropriately qualified nurses and midwives to access the Medicare Benefit Schedule in their own right, not only as determined or delegated by a doctor. They also require rights to prescribe medications and order tests.
The private health fund insurers must also fund comprehensive nursing services in both acute facilities and community settings and client’s homes in their plans.
Such changes will lead to a more holistic health care/maintenance service. These can be coordinated by nurses working in multi-disciplinary teams, close to the patients and their families and within the community.
We can shift the burden of chronic illness and ageing so that it is better managed within the community and less dependent on acute care. | 
