BMJ 2000;320:1043-1048 ( 15 April )

General Practice

Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting "same day" consultations in primary care

Paul Kinnersley, senior lecturer, ^a Elizabeth Anderson, research officer, ^a Kate Parry, statistician, ^b John Clement, general practitioner, ^c Luke Archard, research officer, ^d Pat Turton, director of education, ^e Andrew Stainthorpe, research and development coordinator, ^b Aileen Fraser, nurse practitioner, ^c Chris C Butler, senior research fellow, ^a Chris Rogers, senior statistician. ^b

^a Department of General Practice, University of Wales College of Medicine, Llanedeyrn Health Centre, Cardiff CF3 7PN, ^b Research and Development Support Unit, Trust Headquarters, Southmead Hospital, Bristol BS10 5NB, ^c Gloucester Road Medical Centre, Horfield, Bristol BS7 8SA, ^d London School of Economics Health, London WC2A 2AE, ^e Bristol Cancer Help Centre, Bristol BS8 4PG

Correspondence to: Paul Kinnersley kinnersley{at}cf.ac.uk

Objective: To ascertain any differences between care from nurse practitioners and that from general practitioners for patients seeking "same day" consultations in primary care.
Design: Randomised controlled trial with patients allocated by one of two randomisation schemes (by day or within day).
Setting: 10 general practices in south Wales and south west England.
Subjects: 1368 patients requesting same day consultations.
Main outcome measures: Patient satisfaction, resolution of symptoms and concerns, care provided (prescriptions, investigations, referrals, recall, and length of consultation), information provided to patients, and patients' intentions for seeking care in the future.
Results: Generally patients consulting nurse practitioners were significantly more satisfied with their care, although for adults this difference was not observed in all practices. For children, the mean difference between general and nurse practitioner in percentage satisfaction score was -4.8 (95% confidence interval -6.8 to -2.8), and for adults the differences ranged from -8.8 (-13.6 to -3.9) to 3.8 (-3.3 to 10.8) across the practices. Resolution of symptoms and concerns did not differ between the two groups (odds ratio 1.2 (95% confidence interval 0.8 to 1.8) for symptoms and 1.03 (0.8 to 1.4) for concerns). The number of prescriptions issued, investigations ordered, referrals to secondary care, and reattendances were similar between the two groups. However, patients managed by nurse practitioners reported receiving significantly more information about their illnesses and, in all but one practice, their consultations were significantly longer.
Conclusion: This study supports the wider acceptance of the role of nurse practitioners in providing care to patients requesting same day consultations.

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