Rejected push to increase NP numbers prompts phone call from Health NZ head

Professor Carryer, the executive director of the College of Nursing Aotearoa, told New Zealand Doctor Rata Aotearoa that she received a call this morning from Te Whatu Ora chief executive Margie Apa as a result of the RNZ story.

The nursing schools hope to work with Te Whatu Ora on the issue in the wake of the call, says Professor Carryer who is executive director of the College of Nursing Aotearoa.

“I’m very grateful for the quick response,” says Professor Carryer. She says she and the nursing schools still hope to be able to resolve the NP training funding issue in time for 2023.

“Things are too terrible to wait another year. Why would we waste another year?”

The country currently has more than 615 practising NPs with about 90 new NPs being registered each year, but only 50 of those have their training fully funded through the Nurse Practitioner Training Programme (NPTP).

Professor Carryer says extending NPTP funding of $34,500 per NP trainee for their final year of training was a “tiny bit of money” in the context of the total health budget.

She also emphasised this in the letter she wrote in early May, on behalf of all nursing schools, to the then interim leaders of Te Whatu Ora and Te Aka Whai Ora – Māori Health Authority, urgently calling for all NP trainees to get NPTP funding in 2023 to help resolve unmet health needs.

“The additional investment to produce NPs from existing experienced nurses (approximately $2.87 million for 90 NPs in 2021) is very small in comparison to the investment currently made in GP training (approximately $20 million annually to produce 200 GPs).”

In late June, the Ministry of Health’s chief nursing officer Lorraine Hetaraka and acting deputy director-general of health workforce Andrew Wilson wrote back acknowledging the letter and saying the sector and College of Nurses would be included in the new health entities’ “strategic and planning work” in the coming two years.

Professor Carryer says nursing schools want to see an end of the inequitable two-tier funding system where the 50 NPTP trainees are well supported “and the rest are scrabbling for funding through what were the DHBs”.

“Also many [NP trainees] are self-funding, particularly concerningly, some of the Māori students.”

A recent editorial in the college journal Praxis says 19 of 55 NP candidates responding to an NPTP survey reported self-funding two or more courses towards their clinical masters degree.

In one case a Māori NP candidate working for a Māori health provider had fully self-funded her education, up until the final year of training, without knowing she was eligible for government funding

The NPTP scheme offers a more structured final year of training for NP candidates – than the initial and ongoing parallel training path funded via the former DHBs (for a discretionary amount up to $28,500 per trainee) or, by the nurse themselves.
NPTP trainees have an employer guarantee of a job on registering, greater access to NP mentors and more funded hours of supervised clinical practice.

NPTP scheme director Sandra Oster echoed Professor Carryer’s funding equity as NP trainees “do so much of it on their own dime and on their own time” and cost significantly less than a GP to train.

The University of Auckland academic and NP says about half of the NPTP trainees work in primary care, including stretched general practice, and in aged care, another “sector in crisis”.

Ms Oster, who is also chair of Nurse Practitioners New Zealand, says in recent years she is regularly contacted as NPTP director by primary care employers, including general practices and PHOs, wanting to find an NP candidate to employ.

“They are desperate to get NPs to work in their practice.”

She says she has to explain to them that the best option is to “grow their own” by supporting the training of a nurse already in their practice.

“It is about supporting nurses all through their career path to gain the experience and the skills, supported by their masters degree education, to gain the NP scope of practice”.

The NPTP scheme was first piloted in 2016 by Auckland and Massey universities to provide more structured support to 20 NP trainees a year with initial priorities for nurses working in primary health and aged care.

In 2021 a new contract was funded for a consortium of Auckland, Victoria and Otago universities to deliver the programme to about 50 NP trainees a year with priorities now also including mental health and addiction, and rural health.

There was also additional funding to support more Māori registered nurses to become NPs with the aim of having at least 10 per cent of NPTP candidates Māori. (Currently Māori NPs make up 9.3 per cent of the country’s NPs).

Ms Oster says this year’s NPTP intake has eight Māori nurses out of the 50 trainees (16 per cent).