Developing new roles in general practice
By developing new roles, we are able to re-allocate tasks that might otherwise be done by GPs and nursing staff. This can help patients to receive care in a timely fashion, from the right person first, while freeing up time for clinical staff to do what they’ve been trained for.
The primary care sector is beginning to deal with a serious shortfall in the number of GPs to provide consults.
This puts a huge load on existing GPs and nurses, which in turn makes it harder to attract new doctors and nurses to the sector. By developing new roles, we are able to re-allocate tasks that might otherwise be done by GPs and nursing staff.
In this way, we can ensure that patients are receiving care in a timely fashion, from the right person first, while freeing up time for clinical staff to do what they’ve been trained for — as well as upskill. It also makes for an efficient business model, ensuring all clinicians are working at the top of their scope.
Mātanga tapuhi nurse practitioners have advanced education, clinical training and the demonstrated competence and legal authority to practise beyond the level of a registered nurse. Mātanga tapuhi nurse practitioners work autonomously and in collaborative teams with other health professionals to promote health, prevent disease, and improve access and population health outcomes for a specific patient group or community. Read more about the scope of practice for mātanga tapuhi nurse practitioners on the Nursing Council of New Zealand website.
Read about our nurse practitioner training programme and other post graduate study options for nurses on our website.
In 2020, nurse practitioners were gifted the title Mātanga Tapuhi by the Māori Language Commission. This was noted by New Zealand’s first nurse practitioner, Dr Deborah Harris from the University’s School of Nursing, Midwifery, and Health Practice as a "significant milestone for the profession". Read more on the Victoria University of Wellington website.
Our practice pharmacists bring a depth and breadth of pharmaceutical knowledge and experience to patient care and the clinical team.
This role adds a much-needed specialist skill set to the primary care team. A clinical pharmacist works with the clinical team to target patients with complex health and social care needs who are on multiple medications, ensuring that they maintain an optimal drug regime. They complement the role of the community and hospital pharmacist.
They work to support medicine reviews, compliance and education and are integral to the ‘Year of Care’ approach for patients with higher needs.
In addition, they may also:
- consult with patients, either face-to-face or over the phone
- review medications and answer any questions
- review all hospital discharge notes to check that patients have been given the correct medication and dosage
- follow up discharged patients to avoid any potential problems that could lead to re-admission to hospital
- order blood tests and refer patients for a GP consultation if necessary.
Health improvement practitioners (HIPs) are modelled on the behavioural health consultant roles in the United States. The HIP roles work in an integrated primary mental health and addiction service approach.
A health improvement practitioner is part of the general practice team and is a registered mental health and addiction practitioner.
Being based in a general practice, there are no barriers as to who can see a HIP as long as the person is enrolled in the practice. HIPs keep half of their day for booked appointments and half for unbooked appointments to allow for same-day referrals.
Their work is population-based, meaning people do not require a previous or current mental health or addiction diagnosis to make an appointment. They work in a team approach with the general practice team and can also provide group sessions for a range of issues such as insomnia, gout, anxiety or cardiovascular disease.
General practice staff can do ‘warm handovers’ with the HIP. Consultations are typically short – less than 30 minutes and are focused on evidence-based brief interventions. The HIP will help the patient to agree goals and put the necessary support, follow up in place to help him or her achieve those goals.
The HIP also educates other team members and helps to develop pathways and protocols around mental wellbeing and addiction support.
Health coaches can be dedicated roles within a general practice team or health coaching can be provided through a community health provider working closely with a general practice team. Health coach roles work with other roles in a general practice team including the health improvement practitioner.
The health coach may be a registered or unregistered health practitioner who can help patients with self-management support and with achieving their goals for improved mental wellbeing or lifestyle or behaviour change.
The health coach offers continuity of care as well as emotional support and guidance. Coaches are part of the general practice team but also help people to navigate other services and to get access to any social and cultural support they may need.
Like a HIP, a health coach will typically have half of their day unscheduled so time is available for patients needing or wanting same day appointments.
This is a new role we have introduced to some of our Health Care Home practices. Critical to supporting health and wellness, improving access and engagement along with improving the outcomes of individuals the community health worker is a trusted member of the team and has a close understanding of the local community served. This trusting relationship enables the community health worker to serve as an advocate and conduit between the practice clinical team and patients, supporting behavioural lifestyle changes as part of an overall goal-centred care plan. We are seeing better clinical outcomes such as lower blood sugar levels, weight loss and improved exercise tolerance, engagement in preventative care and medicine compliance from those not using traditional services and patients reporting improvement in mental health and wellbeing. Much of this work occurs in other settings such as the marae and workplace and in peer group consultations rather than the traditional one to one.
There is much evidence to show that this role adds another important dimension to the clinical team and the care a practice can provide, especially in areas of high need. Working alongside the GPs and nurses a social worker will help to support the greater social determinants of health and aimed at improving access and addressing health inequalities.
A complementary, qualified medical role that adds clinical capacity, efficiently. An increasing number of practices are employing physician associates to supplement the clinical team members, especially when there are GP and nursing recruitment issues. They work under the direct supervision of a doctor and are valuable when it comes to supporting timely unplanned care and chronic disease.
The scope of a PAs practice and responsibilities correspond to their supervisor’s practice. In general terms PAs can can obtain medical histories and perform physical exams, order and interpret lab tests, diagnose and manage diseases, perform minor surgery and assist in major surgery and conduct patient education.
It is a misconception that PAs might just take the ‘easy patients’ off your hands. PAs can see any type of patient, regardless of complexity as long as it is correlates to their own training and experience and fits within their supervisor’s scope of practice.
In New Zealand the majority of PAs are currently US trained. This is an intensive masters level qualification, and to be a candidate for the programme you must have a bachelors degree, complete pre-med prerequisite courses and have a minimum of 2,000 hours direct patient contact experience – professions such as paramedics, nurses, pharmacist, pharmacy technician and radiology technicians. A PA is trained as a generalist, in the medical model. They receive over 2,000 hours of clinical rotation and versatility and collaboration are key outcomes sought in the training programme.
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The healthcare landscape is evolving rapidly, with growing demands on general practices to provide high-quality, accessible care to diverse patient populations. As part of this evolution, the integration of paramedics and ECPs into general practice teams is emerging as a powerful strategy to enhance service delivery, improve patient outcomes, and alleviate pressures on traditional healthcare roles. Paramedics and ECPs bring a wealth of skills and experience in acute care, patient assessment, and emergency response. Their inclusion in general practice settings can significantly bolster the capacity of healthcare teams to manage urgent and unscheduled care, offer comprehensive home visits, and provide tailored care for patients with complex needs.
By leveraging the unique competencies of paramedics and ECPs, general practices can enhance patient care, improve workflow efficiency and reduce the burden on general practitioners and nursing staff. This collaborative approach promises to deliver a more resilient and responsive healthcare system, capable of meeting the needs of our communities now and into the future. To learn more, see the Collaborative Aotearoa guide (linked below).
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General Manager - Strategic Development