Places for nurse practitioners to flourish: Examining third sector primary care

Objective: This paper examines and provides an example of the practice environments most likely to nurture nurse practitioner care delivery models and more fully realise the goals of the government's Primary Health Care Strategy. Setting: Non government third sector primary care organisations flourished in New Zealand during a period of neoliberal reform in the 1990s. Because they tend to serve vulnerable populations on a non profit basis, third sector organisations are not typical of owner operator general practices, which have a for profit business imperative. Primary argument: Third sector primary care organisations are ideologically aligned to a core set of social justice values. They involve the community in management and governance structures, and the health professionals employed are salaried. High ratios of nurses to doctors are employed, and nurses work at an advanced level of practice with their patients. Decisions about the use of public funds are made with the community's health needs foremost. Significantly, nurses are able to advance and more fully contribute in ways that may not be so easily achieved amid share holding practice owners. Conclusion: The example of local investment in one third sector primary care provider illustrates that models of care other than the privately owned business model can better serve a high needs and vulnerable population. With minimal structured and coordinated workforce development plans nationally, third sector organisations offer fertile ground in which nurse practitioners can flourish.