Dustin Mitchell
Sep 29

Nurse-Led Clinics: By Necessity and By Design

Nurse-led, by necessity and by design

How the Adelaide general practice behind Keyframe Health built its clinical model around advanced nursing roles

By Dustin Mitchell, Nurse Practitioner and Co-founder, Keyframe Health
Keyframe Health’s courses weren’t designed in a classroom. They were built inside Health on Henley, an independent general practice in Brooklyn Park, in Adelaide’s western suburbs. Its owners are also the founders of Keyframe Health. Every workflow, template and consent conversation we teach was first tested with real patients in that clinic.

This post explains the clinical model behind that work, and why we think more practices can adopt it.

Nursing as the service, not the support layer

At Health on Henley, nursing isn’t a support layer around the work of the GP. It’s a large part of the clinical service. Our team includes two endorsed nurse practitioners and one nurse practitioner candidate, and each of them holds their own patient list.

The practice describes itself as GP and nurse practitioner led, and its ownership reflects that. 

The model began as a response to a workforce problem. It continues because we decided what nurses have the skills and capability to do.

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Two reasons for the same model

The first reason is one most practices will recognise. GP recruitment has been difficult, and our nursing team has absorbed much of the pressure that puts on patient access. Nurse-led appointments add to what our practitioners can do, and they help patients get timely care.

The second reason was deliberate. We set out to be a training environment: somewhere NP candidates work to their full scope while they study, and where the practice creates opportunities for advanced practice rather than leaving nurses to find them elsewhere.

In my experience, nurse practitioner candidates often spend their study years in a job that looks very little like the one they’re training for. Then they’re endorsed and have to learn all of it at once. We wanted to close that gap.

How nurse and GP care work together

Our registered nurses work with practitioners in collaborative, task-sharing arrangements. Under the nurse-led model, a registered nurse:

• performs a structured clinical assessment
• determines eligibility for nurse-led care under a standing order or collaborative care protocol
• documents the clinical encounter
• supports the prescribing decision
• provides patient education and follow-up.

Prescribing authority stays with a practitioner. The RN works through each of those steps so that patients get timely, appropriate treatment in a setting where GP access is limited.

Two of the clearest examples at Health on Henley are nurse-led management of uncomplicated urinary tract infections (UTIs) and medical termination of pregnancy (MTOP).

If you’d like to set up the first of these in your own practice, our nurse-led UTI and nurse-led MTOP courses walk through it.

One service in depth: nurse-led MTOP

Medical termination of pregnancy shows what the model looks like at the advanced end of the range. Working in a collaborative, task-sharing arrangement with the prescribing practitioner, our registerd nurses are involved at nearly every step:

1. Triage and eligibility screening
2. The initial consultation and clinical assessment
3. Supporting informed consent and decision-making
4. Arranging imaging and pathology
5. Medication and aftercare education
6. Triaging complications and escalating where required
7. Follow-up to confirm completion

The prescribing decision stays with the prescriber. Much of what surrounds it, including the time, the explanation and the continuity, sits with the nurse.

That has practical consequences. Early medical abortion is time-critical. When a nurse can complete the assessment and preparation, people are seen sooner and closer to home.

It also shapes the experience of care. People arrive having already made their decision. What they need from us is clinical safety, respect, and enough time that nothing about the process makes an already difficult week harder.

What holds it together

Willingness alone doesn’t make nurse-led services work. They depend on scaffolding:
• Clear eligibility and escalation criteria, so everyone knows who is suitable for nurse-led care and when to hand over
• Scope boundaries agreed and documented with the collaborating prescriber
• Templates and autofills that make safe documentation the default
• Appointment lengths that reflect the actual work, not an idealised version of it
• Supervision that stretches rather than shadows

Once built, that scaffolding can be reused. That’s how Health on Henley made nurse-led services part of its core business. 

Ready to lead MTOP care in your practice?

The Nurse-Led Management of Medical Termination of Pregnancy is 8 hours of APNA-endorsed CPD and includes all of the knowledge, tools and resources needed to implement an MTOP service in your general practice.
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Ready to lead UTI care in your practice?

The Nurse-Led Management of Uncomplicated UTI's is 8 hours of APNA-endorsed CPD and includes all of the knowledge, tools and resources needed to implement a nurse-led UTI service in your general practice.
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