Role of Nurses in Improving Access to GPs Evidence from Practice Nurse Incentive Program Megha Swami PhD Candidate Supervisors: Prof. Anthony Scott Prof. Jenny Williams Prof. Hugh Gravelle

Why nurses important ? Economic argument Input in practice production function Means of Increasing supply capacity Improve access as measured by waiting times But depends on key factors: Health economics – Waiting times function of both Supply & Demand Scope of nurse’s role – Skill mix Evidence that funding structures have significant impact on nurses’ roles

Policy context Nursing in General Practice (NiGP) initiative (launched in 2001) 2001-2011: Nurse specific FFS payments + Practice Incentive Program (PIP) Nurse Incentive Available to practices in RRMA categories 3-7 2012: Introduction of Practice Nurse Incentive Program (PNIP) Funding not tied to specific nurse services - Provides capitation-based payments Available to practices across Australia – Urban practices became newly eligible for nursing incentives

Key research question Could funding structures that allows flexibility in functions that practice nurses can perform lead to reduction in waiting times? Study participation in PNIP using MABEL waves 1-7 (2008-2014) Sample: 675 urban practices with 3,034 observations Outcomes: Two practice waiting time measures Mean waiting time for new patient in practice (days) Mean waiting time for any GP in practice (days)

Participation in PNIP Year Participated Not participated Total 2012 75% [358] 25% [119] 100% [477] 2013 78% [363] 22% [104] 100% [467] 2014 80% [386] 20% [98] 100% [484] Source: MABEL

Participating v/s Not participating practices We control for practice characteristics and characteristics of practice location (postcode level) Variable 2012 2013 2014 Not participated Participated Practice characteristics Proportion of female GPs 0.53 0.54 0.57 0.49 0.56 Proportions of AMGs 0.81 0.75 0.79 GP median age 53.24 51.08* 54.44 50.66*** 56.86 50.83*** No. of GPs 5.45 9.41*** 5.48 9.21*** 9.54*** No. of allied health professionals 0.77 1.52*** 0.90 1.58*** 0.85 1.65*** No. of administrative staff 3.16 5.73*** 3.45 5.81*** 3.28 5.89*** No. of practices 119 358 104 363 98 386

Trends – Key variables

Estimation results Endogenous treatment effects model Allows for simultaneous estimation of PNIP participation (selection) and waiting time (outcome) equations Time-invariant unobserved practice characteristics Participation in PNIP Waiting time for new patient Waiting time for any GP -1.44 days NS -1.04 days NS When control for no. of nurses

Summary Nurses potentially important for improving access to primary care but little quantitative evidence Evidence from MABEL suggests that employment of nurses under flexible funding structures can potentially improve access through expanded role Source: APNA-Creating Opportunities