An NP first for Green Cross Health

You move from being an employee somewhere to really being invested in the community

The first nurse practitioner to buy into a Green Cross practice says she hopes her ownership will help to change the role nursing can play in primary care.

By encouraging nurses to upskill, NP Tamah Clapham would like to see her practice, The Doctors Middlemore, and the wider sector better utilise the work­force and address the staffing crisis.

“I think everyone can upskill and shift along that continuum a little, be­cause there’s so much work to be done,” says Ms Clapham.

The experienced NP says she was de­lighted to be offered the option of part­nership at The Doctors Middlemore a few months ago.

“Nothing really inspired me particu­larly to become a [practice owner]. It wasn’t an aspiration that I held,” she says. “It was more of an opportunity that arose.”

Two long-term owners had recently left the practice, so current sharehold­ers were looking to fill their spots.

The ownership stake gives her re­sponsibility in clinical leadership as well as influencing outcomes and models of care – “how we may be able to improve things”, Ms Clapham says.

“You move from being an employee somewhere to really being invested in the community. When you take up ownership, you’re more committed, there’s higher stakes.

“It was a real opportunity to put down some roots in a community.”

Green Cross Health did not offer Ms Clapham any financial assistance or programmes to assist with buying in, but provided support throughout the process.

The corporate was “hand-hold­ing” several practitioners at once into ownership at The Doctors Middlemore, which was no uncomplicated task, Ms Clapham says.

Buying into a practice is a steep learning curve, on a par with buying a house, she says.

“It depends on your appetite for risk. I think…primary care is a pretty solid investment,” she says.

“It’s like buying a wooden villa or a bungalow in Auckland.”

Ms Clapham started at The Doctors Middlemore two years ago as an NP. The south Auckland practice has 11 full-time practitioners for its 12,000- plus enrolled patients. Ms Clapham is the only NP.

Before moving to The Doctors, she worked in Corrections as an NP in a women’s facility.

She has also led a mobile youth health clinic within alternative educa­tion and worked in a kaupapa Māori clinic at Papakura Marae.

Ms Clapham says being one of the few NP owners in general practice is great representation to show that nurses can take on leadership.

She says training healthcare assis­tants and nurses into roles such as ad­vanced NPs and prescribers could be an answer to the workforce crisis.

If all healthcare workers continued their education and become more qual­ified, this would free up the practition­ers in shortage, she says.

“There’s so much work that regis­tered nurses are doing that could be done by a less-qualified workforce, such as enrolled nurses.

“I’m excited about helping to foster that care for advanced nursing practice. I think it offers a lot to communities by providing better access.”

Utilising NPs in general practice starts with practitioner-inclusive language, she says.

Despite the name of her practice, she points out general practice is moving past calling someone a doctor, to using the terms GP or NP.

As a practitioner with over 1200 pa­tients enrolled in her care, Ms Clapham finds the word “doctor” almost redun­dant, saying all qualified practitioners are “same, same but different”.

“Patients are not too fussed if it’s a GP or NP, from my experience, as long as you can provide for them the care they need,” she says.

While NPs diagnose and prescribe just as GPs do, Ms Clapham says being trained as a nurse means they also take a psychosocial approach to care, rather than the medical model in which GPs are trained.

“Communities with a huge health burden like we have require a holistic approach, which I think nurses are par­ticularly skilled at.”

NPs use the medical model to diag­nose and prescribe for patients but are also aware that, if the patient isn’t going to take the medicine, it won’t be of any help to them. Being an effective practi­tioner means bringing medical and psy­chosocial strategies together by putting the patient at the centre of “team pri­mary healthcare”, Ms Clapham says.

At The Doctors Middlemore, this col­laboration works well, but there is po­tential to upskill staff, she says.

“We haven’t trained an NP yet, but we do have one in our sights – one of our practice nurses is looking at doing prescribing.”

As a profession, nurses are not of­fered support for postgraduate educa­tion compared with medicine. Says Ms Clapham: “You really must be self-dis­ciplined and well resourced to get there.”

Ms Clapham funded her own post­graduate studies while working full time and raising three children.

She advises nurses to continue their study: “The rewards will come.”

NPs are not strong in business own­ership, she adds: “I’m really interested in how to help support that.”