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

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7241.1043 (Published 15 April 2000) Cite this as: BMJ 2000;320:1043
  1. Paul Kinnersley, senior lecturer (kinnersley{at}cf.ac.uk)a,
  2. Elizabeth Anderson, senior lecturera,
  3. Kate Parry, statisticianb,
  4. John Clement, general practitionerc,
  5. Luke Archard, research officerd,
  6. Pat Turton, director of educatione,
  7. Andrew Stainthorpe, research and development coordinatorb,
  8. Aileen Fraser, nurse practitionerc,
  9. Chris C Butler, senior research fellowa,
  10. Chris Rogers, senior statisticianb
  1. a Department of General Practice, University of Wales College of Medicine, Llanedeyrn Health Centre, Cardiff CF3 7PN
  2. b Research and Development Support Unit, Trust Headquarters, Southmead Hospital, Bristol BS10 5NB
  3. c Gloucester Road Medical Centre, Horfield, Bristol BS7 8SA
  4. d London School of Economics Health, London WC2A 2AE
  5. e Bristol Cancer Help Centre, Bristol BS8 4PG
  1. Correspondence to: Paul Kinnersley
  • Accepted 17 February 2000

Abstract

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.

Footnotes

  • Funding The research was supported by a grant from the Welsh Office of Research and Development for Health and Social Care. CB is supported by a fellowship from the Welsh Office of Research and Development for Health and Social Care. The Research and Development Support Unit at Southmead Hospital is supported by a grant from South West NHS Research and Development Directorate.

  • Competing interests None declared.

  • Embedded ImageTwo further tables of results are available on the BMJ's website

  • Accepted 17 February 2000
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