Sue Dunlevy

If you had a solution that could cut the time spent in hospital emergency departments by up to four hours and end frustration of patients who can't get in to see a doctor to get a simple prescription would you take it?

Not if you're a member of the Austtalian Medical Assoc.

What the public and politicians view as a practical way of fixing bottlenecks in our health system the AMA sees as an excuse to start a turf war. That's why they are standing in the way of nurse practitioners, pharmacists and other well trained health professionals taking over routine tasks in our health system to free doctors to do high end medical work.

The AMAs solution to our doctor shortage - training more doctors - will take at least 12 years to bear fruit. But we could be dealing with the long waits to see a GP and hellish emergency department queues now by better using the health professionals we've got.

Struck down by a disabling sinus infection recently I had to resort to a risky cocktail of left-over antibiotics in my medicine cupboard because I could not get a doctors appointment for three days. A colleague was stranded when she couldn't get in to see a doctor for a repeat prescription for the contraceptive pill. And this week the AMA was frightening us with stories of junior doctors working 100 hour weeks, prescribing potentially addictive drugs for themselves and drinking alcohol to cope with stress.

These are just the early signs of a medical workforce crisis that's only going to deepen as our population ages and ageing medicos retire and are replaced by people who don't work their punishingly long working week. Already by some estimates we have a shortage of about 1300 GPs and our medical workforce is being propped up by foreign-trained doctors. Enter the nursepractitioner - one possible early solution to this crisis.

Equipped with a masters degree and specialist training these health workers are already making a remarkable difference. They can prescribe up to 200 medications, order X-rays and blood tests, interpret the results and refer patients to specialists.

They are qualified to treat a range of common ailments, including simple broken bones that don't need surgery, burns, urinary infections, sore ears, kidney stones, rashes and tonsillitis. A study of nurse practitioners working in the emergency department of a major Melbourne hospital found they could deal with about 30 per cent of the patients in the waiting room. Natasha Jennings found patients seen by a nurse practitioner waited just five to 28 minutes to be treated compared to the 11 to 76 minute wait faced by patients treated under a traditional model involving doctors.

The total length of time patients spent was also shorter by up to four hours when nurse practitioners were involved. In some remote areas nurse practitioners are the only form of health care there is. They provide sexual and reproductive health treatment and in South Australia they are trialling training nurses to carry out colonoscopies. What's stopping nurse practitioners taking on a bigger role is our funding system.

Practitioner nurses can't get Medicare rebates when they treat a patient and although they are qualified to prescribe medicines patients can't get Government medicine subsidies when they do. Patients also miss out on Medicare rebates when nurse practitioners order X-rays and blood tests. All this could change with Health Minister Nicola Roxon threatening to lower the Medicare rebates for routine services she thinks can better be provided by nurses than doctors.

Pharmacists have also stuck up their hand asking for prescribing rights for a small range of medicines like the contraceptive pill and common antibiotics to help ease the burden on over-worked GPs. In the UK and the US they have been supplementing their medical workforce with nurse practitioners, pharmacist prescribers for years.

Although patients have been safely treated by such practitioners overseas here in Australia the AMA wants the right to write prescriptions and order medical tests to remain exclusively under the control of doctors. It says nurses haven't got the same level of training as doctors and it would be dangerous to let them loose on patients.

This week a study revealed 90,000 nurses would be retiring over the next 18 years and that up to 66 per cent of nurses were dropping out of training before they completed it. The challenge, it said, was to make nursing a more attractive career. Twenty four hour childcare, more flexible shifts, secure car parking, less stressful workloads and better support for new nurses were called for.

But the study also said nurses needed more autonomy and a wider range of duties if we wanted to keep them. If it cuts emergency department waiting times and helps the sick get faster access to medicines and keeps our nurses at work it's about time we considered expanding their role.