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

doi:10.1136/bmj.320.7241.1048

BMJ 2000;320:1048-1053 ( 15 April )

General Practice

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

P Venning, lecturer, practice nursing, ^a A Durie, research associate, ^a M Roland, professor of general practice, ^b C Roberts, senior lecturer, ^c B Leese, senior research fellow. ^b

^a University of Manchester School of Primary Care, Rusholme Health Centre, Manchester M14 5NP, ^b National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL, ^c Health Care Trials Unit, School of Epidemiology and Health Sciences, University of Manchester

Correspondence to: P Venning, 12 Kingston Road, Didsbury, Manchester M20 2RZ pamelavenning{at}gofree.co.uk

Objective: To compare the cost effectiveness of generalpractitioners and nurse practitioners as first point of contactin primarycare.
Design: Multicentre randomised controlled trial ofpatients requesting an appointment the sameday.
Setting: 20 general practices in England andWales.
Participants: 1716 patients were eligible for randomisation,of whom 1316 agreed to randomisation and 1303 subsequently attendedthe clinic. Data were available for analysis on 1292 patients(651 general practitioner consultations and 641 nurse practitionerconsultations).
Main outcome measures: Consultation process (length of consultation,examinations, prescriptions, referrals), patient satisfaction,health status, return clinic visits over two weeks, andcosts.
Results: Nurse practitioner consultations were significantlylonger 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; oddsratio 1.66, 95% confidence interval 1.04 to 2.66) and asked patientsto return more often (37.2% v 24.8%; 1.93, 1.36 to 2.73). Therewas no significant difference in patterns of prescribing or healthstatus outcome for the two groups. Patients were more satisfiedwith nurse practitioner consultations (mean score 4.40 v 4.24for general practitioners; adjusted difference 0.18, 0.092 to0.257). This difference remained after consultation length wascontrolled for. There was no significant difference in healthservice costs (nurse practitioner £18.11 v general practitioner£20.70; adjusted difference £2.33, $-$ £1.62 to £6.28).
Conclusions: The clinical care and health service costsof nurse practitioners and general practitioners were similar.If nurse practitioners were able to maintain the benefits whilereducing their return consultation rate or shortening consultationtimes, they could be more cost effective than generalpractitioners.

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