1. VISIONARY / PASSIONATE / DYNAMIC CONNECT: UOW Integrated Care What have we learnt from our experiences? Prof Liz Halcomb BN(Hons) RN PhD FACN Professor of Primary Health Care Nursing School of Nursing, UOW

2. VISIONARY / PASSIONATE / DYNAMIC CONNECT: UOW Literature on Integrated Care Largely disease focussed. Many studies report testing of interventions relating to “integrating” care. Many interventions involve the nurse as a “care co-ordinator”.

3. VISIONARY / PASSIONATE / DYNAMIC CONNECT: UOW Nursing in Australian General Practice 2003 – approx. 5,000 nurses and 19,721 GPs 2003 – 40% of practices employed a nurse. 2011-2 - 10,693 nurses and 25,056 GPs. 2012 – 63.3% of practices employed a nurse.

4. VISIONARY / PASSIONATE / DYNAMIC CONNECT: UOW Quit in GP Study NHMRC funded cluster RCT (Zwar et al., 2010) Usual Care / Quitline Referral / Nurse Cessation Intervention Nurses - counsellor and coach & GPs - pharmacotherapy. Roles were described as being solitary activities between the provider and consumer, with limited interaction between the GP and PN.

5. VISIONARY / PASSIONATE / DYNAMIC CONNECT: UOW Quit in GP Study “I don't know what's happening. I haven't had a report, we haven't had a meeting and discussed it” (GP14). “I don't know what my nurses were doing during those interviews to be honest - I wouldn't have a clue” (GP1).

6. VISIONARY / PASSIONATE / DYNAMIC CONNECT: UOW What do we know about collaboration / teamwork in general practice? Limited literature has focussed on how GPs and nurses work together in primary care. Nurses role and scope of practice is not well understood. Business nature of general practice impacts on the way that the nursing role is undertaken.

7. VISIONARY / PASSIONATE / DYNAMIC CONNECT: UOW How is this changing? Removal of item numbers and introduction of the Practice Nurse Incentive Payment. Revision of the Practice Standards for Nurses in General Practice. Timely to undertake research around the ways that doctors and nurses work together in general practice.

8. VISIONARY / PASSIONATE / DYNAMIC CONNECT: UOW Conclusion Improving the ways that doctors and nurses work together in general practice can; –improve the delivery of integrated care and optimise patient health outcomes. –enhance recruitment /retention of staff and reduce burnout, and staff attrition.

9. VISIONARY / PASSIONATE / DYNAMIC CONNECT: UOW References Zwar, N., et al.(2010). Quit in General Practice : a cluster randomised trial of enhanced in-practice support for smoking cessation. BMC Family Practice, 11, 59. Australian Medicare Local Alliance. General Practice nurse national survey report. 2012 [cited 2013 September 18th ]; Available from: http://amlalliance.com.au/__data/assets/pdf_file/0003/46731/2012- General-Practice-Nurse-National-Survey-Report.pdf.http://amlalliance.com.au/__data/assets/pdf_file/0003/46731/2012- General-Practice-Nurse-National-Survey-Report.pdf Australian Institute of Health and Welfare, Medical workforce 2011, in National health workforce series no.3, Australian Institute of Health and Welfare, Editor. 2013: Canberra. Australian Divisions of General Practice Ltd. National practice nurse workforce survey 2003. 2003 [cited 2010 May 30]; Available from: http://generalpracticenursing.com.au/__data/assets/pdf_file/0006/15378/National-Practice-Nurse- Workforce-Survey-2003.pdf. http://generalpracticenursing.com.au/__data/assets/pdf_file/0006/15378/National-Practice-Nurse- Workforce-Survey-2003.pdf