However, some PCPAs who were not totally satisfied with their scope of practice said that at times they had felt that some of the nurses did not value the PCPA as well as they should. This related to PCPAs not having the ability to block off time to complete set tasks and to have to accept less attractive jobs from a range of other members of the practice: The nurses treat me as if I am a step down from them and fob off the unpleasant jobs on me (#12) They treat us as lackeys sometimes (#14) We are not getting time to do our set tasks – we can’t block out time – the nurses don’t realise how busy we are (#12) The current position reported by all the PCPAs was that the registered nurses in their practices liked the PCPA addition to the practice. One of the clinics had handed over the entire recall system to the PCPA. Individual PCPAs who reported specific innovations in their practices which had resulted from their new role included: Helping with Cornerstone accreditation Doing pre-assess/triage for more doctors Combing new patient notes identifying illness/recalls and things that need doing before a consultation Revamped the recall system Before school check administration Helping doctors with skin clinic Freeing up nurses have allowed them to do a diabetes clinic for a full day. The roles which would normally have been done by a registered nurse and which were now being done by the PCPA are listed below. PCPA reported skills and tasks: Recalls – 12 Dressings(basic) – 10 Giving results – 7 Restocking – 7 Pre-assessment – 7 Assisting with minor surgery – 6 Recordings/observations – 6 Autoclaving – 5 Pregnancy tests/urine tests – 5 Dashboard - 5 Venepuncture – 3 Visual acuity – 3 New patient reviews – 3 ECG – 3 Chaperoning – 2 Answering the nurse phone – 2 Chasing results – 2 Interpreting – 1 Health and safety - 1 Receptionists The PCPAs also reported that the receptionists were currently positive about the role. As the majority of PCPAs had been in reception or administration in the practice before the demonstration programme, they currently had allocated time slots as
enrolled nurse Assisting in theatre Sterilising instruments Assisting with plastering (previously required two RNs) Escorting patients to radiology and laboratory Data entry 9 Recalls Assists with wound care Minor surgery Data entry Preparation of rest home residents prescriptions Data entry related to rest homes Answers nurses’ phones Unable to quantify 10 Urinalysis Pregnancy tests Practice management (previously receptionist) BPs, weight, height Unable to quantify Appendix 11: Evidence of nurses working at a higher level PN New tasks Nurse-led clinic increase Paperwork reduction Preventative care 1 Sees people more opportunistically Increase in patient numbers attending practice as result of PCPA - reminders etc No increase in nurse-led clinics Huge reduction in administration Factory visits for immunisations no longer require two nurses Spending more time on patient education Increased CVD assessments, increased cervical smear rates 2 Spending more time on nursing activities Clinic is more productive as RN has time to do COPD, diabetes Performance on primary care targets improving as a result Increase in number of CVD clinics and more attending Less paperwork More more time for prevention 3 PCPA described as ‘useless’ and delegated roles taken back Disappointing outcome Slight reduction in paperwork, PCPA does recalls for immunisations, smears, mammograms No change
4 No new tasks, but reducing patient waiting time as simple tasks can be done by PCPA More time spent with patients, no clinic increase Yes – PAs loading smoking cessation data on to patient records No longer does patient recalls No increase 5 More new patient checks done Recent merger of practices No effect on clinic increases Made huge difference to paperwork for RN Practice would like to get two PCPAs instead of one RN (opportunity offers) PCPA answering phones, releasing enrolled nurse to do checks, immigration medicals, flu vaccines and smoking cessation (raised her position to near RN) 6 None None Some No change 7 More time to concentrate on clinical tasks Drs able to see more walk-ins No increase in nurse led clinics, but not as pressured Drs have more time with patients Does ACC claims Significant reduction in general administration in practice More time for smoking cessation and asthma clinics 8 None None – have lost funding for B4School checks to Plunket (not related) Reduction in paperwork, including data entry for new patients No apparent change Appendix 12: Practice manager interviews The questions were divided into eight broad categories: Time factors Meeting health targets Practice population Practice manager’s estimation of services Workload of GPs and nurses Financial considerations of a PCPA in the practices Perception of future and role of PCPA. To increase the spread of the interviews, some practice managers were interviewed who were in a practice where no GP was interviewed (see practice manager interviews, page 35).