Nambucca Valley Care's Jenny Zirkler believes innovation will save a choked healthcare system

As former head of nursing at Macksville Hospital, and current executive care manager at Nambucca Valley Care, Jenny Zirkler, has seen the system from multiple angles, giving her a unique insight into what ails it, and, what to do about it.

Despite bloated emergency departments, long gone are the days when most GPs would do time at the region’s hospitals, although Jenny does admit that model was mostly unsustainable.

And there is less desire from some doctors to continue treating elderly patients once they enter an aged care facility, meaning that legacy of family and patient history (and trust) is lost.

“That’s a problem for us,” she said.

“Sometimes the younger doctors coming, I don’t think they think there’s any incentive [to take patients in aged care].

Every time Jenny hears of another doctor going into retirement she gasps.

“But the GPs that do come in are generally very good and we thank them for continuing to come in,” she said.

“Doctors are just so busy these days that often for them to come here they have to go on their lunchbreak or do overtime.”

Jenny suggests we shouldn’t be putting all our eggs in one basket in the vain hope that we attract some new GPs to regional Australia.

“You can’t change what you can’t change, so you've just got to be a little bit innovative,” she said.

One of those innovations is allowing trained nurses to shoulder some of the load of our doctors. 

“GPs don’t generally like nurse practitioners, some of them think it’s a bit of a threat,” she said.

“But I think you get good value out of them – they don’t take money, they take the load.”

A few local practices have already adopted this idea in order to service the thousands of patients on a solitary doctor’s books.

But it could go further.

Nurses are already entrusted to write up medication charts, perhaps those charts should be allowed to act as prescriptions, cutting out the GP middle man.

Jenny admits that this would inevitably cause a domino effect resulting in a future shortage of nurses.

“But what goes around comes around,” she said, pointing out the half dozen new nursing graduates from the new NVC training facility here in Macksville.

“And pharmacists can do a lot too.”’

She also says that if governments legislated the acceptance of digital signatures and funded telehealth appointments for GPs like they do for specialists, this might go some way to alleviating doctors’ time constraints.

Another issue for aged care facilities in the Valley, she said, is that new residents are making the move much later in life, once they’ve already reached the stage of needing palliative care.

“I think it’s better if they come in before that stage so they can socialise a bit first,” she said.

“We find that when they do, they’re more likely to physically improve because their quality of life is improved.”

And by extending their physical independence, it would go some way to lessening the demand on local GPs.

The problem, of course, is that aged care facilities receive funding in line with the resident’s care needs. To put it bluntly: the sicker the person the more money is doled out by the government.

“But from a moral point of view, we’d prefer them to come in earlier,” Jenny said.

“I love coming in here and seeing staff up dancing with residents in the middle of the floor.

Two of Jenny’s goals are to break down the stigma attached to ‘old folk’s homes’, and creating a dementia-friendly community.

“I’m very big on looking at alternative models,” she said.

The last idea that Jenny discussed was to lessen the burden on the healthcare system and decrease risk of complications from excessive invasive surgery by earlier advanced care planning.

Many people already plan what to do with their money and their organs in the event of sudden death, but Jenny said that most people are unaware of the extent that the healthcare system tries to keep people alive, even when it is against the person’s best interests.

She advises that a proper treatment plan should be talked about prior to entering an aged care facility.

“As more and more people are ageing, we can’t afford to keep everyone alive – I know that’s a terrible thing to say, but it’s reality,” she said.

“For me, it’s not about the length of your life, it’s about the quality.”