156 Australian Health Review May 2005 Vol 29 No 2 Health Policy and Planning Aust Health Rev ISSN: 0156-5788 2 May 2005 29 2 156-166 'Aust Health Rev 2005 www.aushealthre- view.com.au Health Policy and Planning Abstract Primary health care services, such as general practices, are the first point of contact for many Australian health care consumers. Until recently, the role of nursing in Australian primary care was poorly defined and described in the literature. Changes in policy and funding have given rise to an expansion of the nursing role in primary care. This paper provides a review of the literature and seeks to identify the barriers and facilitators to implementation of the practice nurse role in Aus- tralia and identifies strategic directions for future Aust Health Rev 2005: 29(2): 156–166 research and policy development. THE GENERAL PRACTITIONER (GP) remains the broker and gatekeeper to health care services in Australia, with some 90% of Australians visiting a GP each year. 1 The clinical skills, expertise and knowledge level of clinicians working in primary care have evolved to meet the challenges created by a more informed consumer, advances in medi- cal technology and a drive for improved health service outcomes. 2 This paper seeks to outline the contribution of practice nurses to Australian primary health care, describe the international experience relating to practice nurse role develop- ment, determine the scope of the clinical practice boundaries and identify the barriers and facilita- tors to the practice nurse’s role. The growth of the nursing role in Australian primary care has been driven by multiple factors including the changing health care needs of con- sumers, shortage of GPs in rural areas and gener- ally increasing GP workloads nationwide. The term “practice nurse” refers to either a State Board Registered or Enrolled Nurse who is employed to provide nursing services in the setting of general Nursing in Australian general practice: directions and perspectives Elizabeth J Halcomb, Patricia M Davidson, John P Daly, Rhonda Griffiths, Julie Yallop and Geoffrey Tofler What is known about the topic? Following the recognition of the benefits of general practice nursing there has been growth in this nursing practice in the United Kingdom, New Zealand and, to a lesser extent, Australia, yet the role and scope of practice remains unclear. What does this study add? This study provides a literature review of practice nursing and discusses the many barriers and facilitators to enhancement of this role in Australia. What are the implications for practice? The authors call for leadership from professional nursing bodies to define and develop the role, accompanied by discussion and debate throughout the health care system on the contribution of practice nursing to enhancing patient outcomes through collaborative models of care. Elizabeth J Halcomb, RN, BN(Hons), GradCertIC, Doctoral candidate John P Daly, RN, MEd(Hons), PhD, Professor of Nursing and Foundation Head of School School of Nursing, Family and Community Health, University of Western Sydney, Sydney, NSW. Patricia M Davidson, RN, MEd, PhD, Associate Professor of Nursing and Director Nursing Research Unit, University of Western Sydney and Western Sydney Area Health Service, Sydney, NSW. Rhonda Griffiths, RN, CM, DrPH, Professor of Nursing and Director Center for Applied Nursing Research, University of Western Sydney and South Western Sydney Area Health Service, Sydney, NSW. Julie Yallop, RN, Senior Research Fellow Cardiovascular Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC. Geoffrey Tofler, MB BS, MD, FRACP, Professor of Cardiology Department of Cardiology, Royal North Shore Hospital, Sydney, NSW. Correspondence: Mrs Elizabeth J Halcomb, School of Nursing, Family and Community Health, University of Western Sydney, Locked Bag 1797, Penrith South DC, Sydney, NSW 1797. e.halcomb@uws.edu.au