Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2000 Apr 15;320(7241):1048-53.
doi: 10.1136/bmj.320.7241.1048.

Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care

P Venning  1 , A Durie, M Roland, C Roberts, B Leese
Affiliations
Clinical Trial

Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care

P Venning et al. BMJ. .

Abstract

Objective: To compare the cost effectiveness of general practitioners and nurse practitioners as first point of contact in primary care.

Design: Multicentre randomised controlled trial of patients requesting an appointment the same day.

Setting: 20 general practices in England and Wales.

Participants: 1716 patients were eligible for randomisation, of whom 1316 agreed to randomisation and 1303 subsequently attended the clinic. Data were available for analysis on 1292 patients (651 general practitioner consultations and 641 nurse practitioner consultations).

Main outcome measures: Consultation process (length of consultation, examinations, prescriptions, referrals), patient satisfaction, health status, return clinic visits over two weeks, and costs.

Results: Nurse practitioner consultations were significantly longer than those of the general practitioners (11.57 v 7.28 min; adjusted difference 4. 20, 95% confidence interval 2.98 to 5.41), and nurses carried out more tests (8.7% v 5.6% of patients; odds ratio 1.66, 95% confidence interval 1.04 to 2.66) and asked patients to return more often (37. 2% v 24.8%; 1.93, 1.36 to 2.73). There was no significant difference in patterns of prescribing or health status outcome for the two groups. Patients were more satisfied with nurse practitioner consultations (mean score 4.40 v 4.24 for general practitioners; adjusted difference 0.18, 0.092 to 0.257). This difference remained after consultation length was controlled for. There was no significant difference in health service costs (nurse practitioner 18.ll pound sterling v general practitioner 20.70 pound sterling adjusted difference 2.33 pound sterling - 1.62 pound sterling to 6.28 pound sterling).

Conclusions: The clinical care an health service costs of nurse practitioners and general practitioners were similar. If nurse practitioners were able to maintain the benefits while reducing their return consultation rate or shortening consultation times, they could be more cost effective than general practitioners.

PubMed Disclaimer

Figures

Figure
Figure
Flow chart tracking patients through study
See this image and copyright information in PMC

Comment in

References

    1. Royal College of Nursing. Nurse practitioners in primary health care—role definition. London: RCN; 1989.
    1. Department of Health. New opportunities for NHS Direct. London: DoH; 1999. . (Press release 1999/0227.)
    1. Department of Health. Up to £30 million to develop 20 NHS fast access walk-in centres. London: DoH; 1999. . (Press release 1999/0226.)
    1. South Thames Regional Health Authority. Evaluation of nurse practitioner pilot projects: summary report. London: Touche Roche Management Consultants, STRATA; 1994.
    1. University of Newcastle Upon Tyne, Centre for Health Services Research. Evaluation of nurse practitioners in general practice in Northumberland: the EROS projects 1 and 2. Newcastle Upon Tyne: CHSR; 1998.

Publication types

MeSH terms