CHRIS WALLIS - PRIMARY CARE NP/NURSE NAVIGATOR

Working as a Nurse Practitioner for West Moreton Hospital and Health Services, Chris has a unique and challenging position for prison health services.

After graduating as a nurse in 2001, Chris spent the early years of his career working as an RN at the PA Hospital in Brisbane before moving to corrective nursing in 2008 to provide much-needed health care services for prisoners.

Growing up in Toowoomba and now living in Jimboomba, Chris spends his time across four corrective services providing primary health care to adult prisons including Brisbane Correctional Centre, Brisbane Women’s Correctional Centre, Walston Correctional Centre and Borallon Correctional Centre - all up over 2700 prisoners in total.

After qualifying as NP 18 months ago, Chris now provides primary health care within the West Moreton Health Service alongside six other Queensland NPs with speciality areas including chronic conditions, aged care, palliative care and chronic pain management. Interestingly, West Moreton Health Services is believed to have the most NPs in a single service in Qld.

Can you share a little about the community you are working in and the nursing you are providing to patients?

In my current role, I have been working as a Nurse Navigator/NP - looking at blood born viruses and the management of Hep C treatment across the prisons.

Space in the medical centres is limited in the prison system, and access to prisoners can be often difficult – so it is often not as straightforward as having your patients readily available in the waiting room for you to see - it is a very challenging process sometimes to give even simple health care, and that is what really makes our job so interesting.

I access, diagnose and treat patients with Hepatitis C infection in the West Moreton Health prison system. I look at patient results and assess who needs treatment. I work closely with the team at the PA Hospital and work through treatment plans to ensure my patients have an equitable access to care to those living in the community.

I was also trained at the PA Hospital to use a Fibroscan, which helps in the diagnosis of liver cirrhosis due to longstanding Hepatitis C virus infection. The Fibroscan is utilised daily to assist with identifying those at higher risk of advanced liver disease and expedite a referral to the Hepatology Department at the PA Hospital for further management. Having our own mobile Fibroscan machine allows rapid assessment of liver fibrosis within the prisons, rather than requiring prisoners to be transported to the PA Hospital for Fibroscan.

Officially in the prison system, there is a 30% to 40% rate of people with Hepatitis C in their system, however, anecdotally the rate would probably be higher. This assessment, diagnosis and treatment is essential and works to ensure the long-term health of our prisoners.

This role is unique throughout the prison system in Queensland currently, with some similar roles active in other states around Australia.

As well as doing my role, I also help the medical team on site and rotate through the weekend shift of primary care to ensure prisoners get the care they need.

What is unique about your role in the community?

My role is a nursing role that allows me to take my patients a few steps further in the health journey. I am proud to offer the healthcare we are providing and provide prisoners with health plans to help them.

The main reason I decided to do the NP course was that I wanted to autonomously manage patients and help them holistically and improve my scope of practice. Now that I am a qualified NP I can deliver a nurse-led model of care but with a lot more benefits to the patient than a traditional nurse can provide.

A typical day in the life of me as an NP would include…

At our prisons and corrective centres, the medical care is run much like a traditional primary healthcare centre.

We have a wait list of prisoners at each centre that is managed by the senior nursing staff, and I have a list of people who are requesting Hep C treatment or newly diagnosed patients. The prisoners are called down to the medical centre to get care, and we see them as they get called.

A spanner can be thrown into the process should an event happen at one of the prisons such as lockdowns or assaults as then the patients waiting for health care or treatment can’t access the care they need.

What are you hoping to achieve in your current role as an NP?

Patients in the correctional system lose access to Medicare upon entry, which means that while their healthcare is funded by the government, Hep C treatment prescriptions must be dispensed through a hospital pharmacy which can be problematic and slow down access to treatment. Ideally, if we can streamline the process, our patients will more readily get access to the drugs they need for Hepatitis C treatment.

In the short term, we are actively lobbying the Pharmaceutical Benefits Advisory Committee to have S100 prescriptions authorised by NP’s, rather than our patients needing a Medical Officer to write the prescriptions. The inability for NP’s to generate S100 scripts for Hep C treatments is a barrier to an effective and rapid cure of this disease in the prison system.

In the long term, our goal is to see the Hepatitis C program be a permanent role (currently it is just a 3-year funded program) and a result see a rapid decrease in Hep C infection rates in the correctional system Australia wide.