Nurses working to their full scope of practice are the solution to primary care gaps, says healthcare pioneer Haley Hodgson.

Haley Hodgson was working as a practice nurse in the Northern Rivers town of Maclean when her clinic’s future was threatened by the looming retirement of its GP.

There was no obvious replacement; no one wanted to buy the clinic, and Maclean, like many rural communities, was losing doctors fast.

So, Haley found a solution: she bought the clinic herself.

Haley, who is a transitional nurse practitioner, addressed the NSWNMA’s 2026 Professional Day in July.

“(The clinic) was one of the original buildings in the town of Maclean, and they were just going to close the doors,” she said.

“And so I said, ‘Why can’t I buy it?’ And I was told I couldn’t because I wasn’t a doctor. But I did. That was four years ago.”

At first, she ran the clinic with a part-time doctor and part-time receptionist. After six months, she reorganised it as a nurse-led clinic named AvenuPlus. In its first year it had more than 10,000 presentations in a population of about 25,000.

“85 per cent (of presentations) said they would have gone to the emergency department had we not been there, and we had an average wait time of three minutes,” she said.

Hayley opened a second AvenuPlus clinic in the nearby city of Grafton in March this year. Both clinics advertise “walkin access health care, led by nurses – without the GP wait”.

Haley’s latest move was to open Maclean’s only private radiology unit – including MRT, ultrasound, and bone density services – to address the lack of local access to diagnostic imaging in the town.

“I rang every radiology clinic… in New South Wales and Queensland, and none of them wanted to come to the area. So, I decided to open my own,” she said.

“Why should our community go without? Why should we have to travel two hours to the nearest city to get scans? I just thought it was ridiculous.”

She had to overcome resistance from banks and other lenders who were hesitant to fund a nurse-led project.

“I was told I was a middle-aged woman who was a nurse, which isn’t a profession that is worthy of lending millions of dollars to build something.

“And I was crazy, and I had a mortgage, and I had children, and so no bank would touch me… (but) I wasn’t taking no for an answer, and I kept fighting and fighting.”

Hayley said she built a case for funding by using clinic presentation data and RACGP statistics to prove demand and the lack of GPs in the area.

It cost about $180,000 to open a clinic, she said. “I’ve got the model of care sitting there, ready for anyone that wants to pick it up and open up elsewhere.”

While the clinics are led by nurse practitioners and RNs, Hayley emphasised the critical role of enrolled nurses.

“Our clinic thrives because of our enrolled nurses. They are bloody amazing (but) they really want to be able to work to the top of their scope, and we allow them to do that in this space.”

She said AvenuPlus was about to get a badly needed endorsed midwife. “In the first week we opened at Grafton, we had 18 women that were in the first trimester of pregnancy that did not have a GP.

“They were going through without any antenatal care whatsoever. Nurse practitioners and endorsed midwives are definitely going to sit in that space amazingly well.”

She said AvenuPlus would also get a mental health nurse practitioner soon. “Rural communities cannot wait for the perfect workforce conditions. We already know there’s not enough GPs across Australia, but in the country it’s much worse.

“My idea is that nurse practitioners and endorsed midwives will essentially, in primary healthcare in regional or rural towns, take over from the GPs.

“There’s absolutely a need in this country for GPs and doctors. But it’s about building teams where every profession can work to their full scope.”

Hayley said AvenuPlus clinics have to charge a flat $60 private fee because the Medicare rebate for nurse practitioners and endorsed midwives is only $27 – too low to cover costs. “(A fee) is not ideal, especially in some locations, but it’s either that or we’re out.”

Hayley called on nurses to take action to help stem the decline of primary health care services – especially in non-metropolitan areas.

“When communities cannot access care, we have a responsibility to do more than just describe the problem.

“We need to take some ownership, and we must be prepared to build the solution, which is what I’ve attempted to do.”

Call to abandon pervasive ‘illness model’

Australian healthcare needs to shift from “an illness model to a wellness model and a prevention model” said Francis Rice, chief nursing officer at the Australian College of Nursing.

Greater emphasis on preventive healthcare would reduce the strain on the nursing workforce, Rice told the NSWNMA Professional Day.

She said Australia will need at least 80,000 more nurses by 2035.

“I think we do a reasonable job of recruiting nurses into the profession,” Rice said. “We’ve got good pipelines. We’ve got great numbers of students coming through programs in nursing and midwifery. Then we struggle to keep them in the profession.

“We have a retention issue, and so we need to be doing better to keep nurses engaged in that profession.

“As you all know, it’s a very challenging thing to do. There is lots of policy. There’s lots of systemic issues, violence from consumers, bullying and challenging behaviour from our colleagues, pay and shift work, and so many things that are systemic and not very easy to change.

“We work in an illness model, and we need to be working in a wellness model and a prevention model.”