BMJ  2004;328:927 (17 April), doi:10.1136/bmj.38041.493519.EE (published 6 April 2004)

Primary care

Impact of nurse practitioners on workload of general practitioners: randomised controlled trial

¹ Centre for Quality of Care Research (WOK), University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, Netherlands, ² National Primary Care Research and Development Centre (NPCRDC), University of Manchester, Manchester M13 9PL

Objective To examine the impact on general practitioners' workload of adding nurse practitioners to the general practice team.

Design Randomised controlled trial with measurements before and after the introduction of nurse practitioners.

Setting 34 general practices in a southern region of the Netherlands.

Participants 48 general practitioners.

Intervention Five nurses were randomly allocated to general practitioners to undertake specific elements of care according to agreed guidelines. The control group received no nurse.

Main outcome measures Objective workload, derived from 28 day diaries, included the number of contacts per day for each of three conditions (chronic obstructive pulmonary disease or asthma, dementia, cancer), by type of consultation (in practice, telephone, home visit), and by time of day (surgery hours, out of hours). Subjective workload was measured by using a validated questionnaire. Outcomes were measured six months before and 18 months after the intervention.

Results The number of contacts during surgery hours increased in the intervention group compared with the control group (P < 0.06), particularly for patients with chronic obstructive pulmonary disease or asthma (P < 0.01). The number of consultations out of hours declined slightly in the intervention group compared with the control group, but this difference did not reach significance. No significant changes became apparent in subjective workload.

Conclusion Adding nurse practitioners to general practice teams did not reduce the workload of general practitioners, at least in the short term. This implies that nurse practitioners are used as supplements, rather than substitutes, for care given by general practitioners.

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