1. 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

2. 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

3. Policy context
Nursing in General Practice (NiGP) initiative (launched in 2001)
: 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

4. 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 ( )
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)

5. 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

6. 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

7. Trends – Key variables

8. 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

9. 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