BMJ 2000;320:1038-1043 ( 15 April )

General Practice

Nurse management of patients with minor illnesses in general practice: multicentre, randomised controlled trial

Chau Shum, general practitioner, ^a Ann Humphreys, health visitor, ^b David Wheeler, general practitioner, ^c Mary-Ann Cochrane, practice nurse, ^c See Skoda, research assistant, ^d Sarah Clement, lecturer in health services research. ^e

^a Walderslade Village Surgery, Walderslade ME5 9LD, ^b Lordswood Health Centre, Chatham ME5 8TJ, ^c Gallions Reach Medical Centre, London SE28 5BE, ^d Medway Doctors on Call, Chatham ME4 4TE, ^e Department of General Practice and Primary Care, Guy's, King's College, and St Thomas's Hospitals School of Medicine, London SE11 6SP

Correspondence to: C Shum c.shum{at}which.net

Objective: To assess the acceptability and safety of a minor illness service led by practice nurses in general practice.
Design: Multicentre, randomised controlled trial.
Setting: 5 general practices in south east London and Kent representing semi-rural, suburban, and urban settings.
Participants: 1815 patients requesting and offered same day appointments by receptionists.
Intervention: Patients were assigned to treatment by either a specially trained nurse or a general practitioner. Patients seen by a nurse were referred to a general practitioner when appropriate.
Main outcome measures: The general satisfaction of the patients as measured by the consultation satisfaction questionnaire. Other outcome measures included the length of the consultation, number of prescriptions written, rates of referral to general practitioners, patient's reported health status, patient's anticipated behaviour in seeking health care in future, and number of patients who returned to the surgery, visits to accident and emergency, and out of hours calls to doctors.
Results: Patients were very satisfied with both nurses and doctors, but they were significantly more satisfied with their consultations with nurses (mean (SD) score of satisfaction 78.6 (16.0) of 100 points for nurses v 76.4 (17.8) for doctors; 95% confidence interval for difference between means 4.07 to 0.38). Consultations with nurses took about 10 minutes compared with about 8 minutes for consultations with doctors. Nurses and doctors wrote prescriptions for a similar proportion of patients (nurses 481/736 (65.4%) v doctors 518/816 (63.5%)). 577/790 (73%) patients seen by nurses were managed without any input from doctors.
Conclusion: Practice nurses seem to offer an effective service for patients with minor illnesses who request same day appointments.

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