Trust skilled nurses enough, fund their activities properly and who knows where we might end up. Efficient healthcare, anyone?
There are times when the clunkiness and sheer bloody-minded inflexibility of our beloved Medicare system can be truly brain-numbing.
I have been cursed the last several weeks with a superficial surgery scar which went inconveniently manky on me, thanks to what my surgeon called a “very boring” staph infection. God bless boring, because anything more exciting than that would have done my head in, seriously.
As a result I have needed to have dressings changed and the wound repacked on a semi-regular basis over the last couple of weeks.
My lovely GP, who frankly I would crawl over broken glass to see, took one look and said “I’m sending you to see Maggie”.
Maggie, it turned out, was a practice nurse with a deft touch with wounds – a Hermione Grainger of Healing, if you will. A 10-minute conversation with Maggie led to me buying some whizz-bang wound packing online at her recommendation and another appointment made to put the magic stuff in place.
(As an aside, why is it that a patient needs to buy wound dressings online from her own pocket? Why aren’t — or can’t — general practices and hospitals, for that matter, supplying the best available as a matter of standard practice? But I digress.)
Back I went on Monday, and I was laid out on the bed, wound unpacked and washed, new dressing ready to go, while Maggie leaned on the bench, contemplating the universe.
“What are we waiting on,” I asked.
“GP,” she said.
“Why do we need a GP,” I asked.
“Can’t bill Medicare without a GP,” she said.
Sigh.
The GP, of course, like all GPs everywhere, was running 20 minutes late. She also wasn’t my GP, so when she did stick her head around the curtain, I had to recount the whole messy history for her, including why I needed a 15-year-old foreign body left behind by an earlier surgeon removed in the first place (trust me, you don’t want to know).
Ten minutes later, the GP said “okay, go for it” and wandered off.
Ninety seconds later – I timed it, people – I was on my way out the door, wound packed, new dressing in place. I forked out $61.70 for the pleasure, got $41.40 back for the Item 23 consult and life moved on.
Item 23, of course, is for:
“Professional attendance by a GP at consulting rooms … lasting at least six minutes and less than 20 minutes and including any of the following that are clinically relevant:
(a) taking a patient history;
(b) performing a clinical examination;
(c) arranging any necessary investigation;
(d) implementing a management plan;
(e) providing appropriate preventive health care;
for one or more health-related issues, with appropriate documentation.”
Never mind that the presence of a GP was totally unnecessary. Never mind that the GP was pulled away from her list of regular patients in order to tick an administrative box, making her, presumably, half an hour late rather than 20 minutes.
Never mind that this nurse had skills every GP in the clinic deferred to. Never mind the years of experience and training under her belt. Never mind that both the nurse and I were held up for about 20 times longer than we needed to be.
According to Services Australia there are only four MBS items that can be claimed for practice nurse activities, and only three of them can be billed without the presence of a doctor:
- 10987: health assessment follow-up with an Aboriginal and Torres Strait Islander patient who has already had a health assessment from a doctor;
- 10997: chronic disease monitoring and support provided between structured reviews by the patient’s usual medical practitioner; and
- 16400: antenatal service at or from an eligible practice location in a regional, rural or remote area.
This is madness, people.
Valuing nurses like Maggie includes trusting them with the keys to working top of their scope without being “supervised” by a GP who doesn’t have the same skills, and what’s more, doesn’t want to have them. Nor, I suspect, do they feel they need to supervise.
It also involves appropriately funding their activities.
It sounds like a little thing, and perhaps it is, but after all, out of little things great big, efficient, complex systems grow.
All power to the Maggies of the world.
Do you have a story tip for us, or a topic you would like to see us cover? Contact the editor at editor@healthservicesdaily.com.au.