title: Following the funding trail: financing, nurses and teamwork in Australian general practice.
abstract: BACKGROUND
  Across the globe the emphasis on roles and responsibilities of primary care teams is under scrutiny. This paper begins with a review of general practice financing in Australia, and how nurses are currently funded. We then examine the influence on funding structures on the role of the nurse. We set out three dilemmas for policy-makers in this area: lack of an evidence base for incentives, possible untoward impacts on interdisciplinary functioning, and the substitution/enhancement debate.
  
  
  METHODS
  This three year, multimethod study undertook rapid appraisal of 25 general practices and year-long studies in seven practices where a change was introduced to the role of the nurse. Data collected included interviews with nurses (n = 36), doctors (n = 24), and managers (n = 22), structured observation of the practice nurse (51 hours of observation), and detailed case studies of the change process in the seven year-long studies.
  
  
  RESULTS
  Despite specific fee-for-service funding being available, only 6% of nurse activities generated such a fee. Yet the influence of the funding was to focus nurse activity on areas that they perceived were peripheral to their roles within the practice.
  
  
  CONCLUSIONS
  Interprofessional relationships and organisational climate in general practices are highly influential in terms of nursing role and the ability of practices to respond to and utilise funding mechanisms. These factors need to be considered, and the development of optimal teamwork supported in the design and implementation of further initiatives that financially support nursing in general practice.
authors.affiliation: Melbourne East General Practice Network, Blackburn, Victoria, Australia. drchrispearce@mac.com
authors.forename: Christopher
authors.initials: C
authors.lastname: Pearce
authors.forename: Christine
authors.initials: C
authors.lastname: Phillips
authors.forename: Sally
authors.initials: S
authors.lastname: Hall
authors.forename: Bonnie
authors.initials: B
authors.lastname: Sibbald
authors.forename: Julie
authors.initials: J
authors.lastname: Porritt
authors.forename: Rachael
authors.initials: R
authors.lastname: Yates
authors.forename: Kathryn
authors.initials: K
authors.lastname: Dwan
authors.forename: Marjan
authors.initials: M
authors.lastname: Kljakovic
mesh_terms: D001315:Australia; D003299:Cooperative Behavior; D005380:Financing, Government / Q000458:organization & administration*; D058006:General Practice / Q000191:economics*; D006282:Health Personnel; D007407:Interviews as Topic; D009740:Nursing Staff / Q000191:economics*; D010348:Patient Care Team; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration