Intended for healthcare professionals

Primary Care

Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors

BMJ 2002; 324 doi: (Published 06 April 2002) Cite this as: BMJ 2002;324:819
  1. Sue Horrocks, research associatea,
  2. Elizabeth Anderson, senior lecturerb,
  3. Chris Salisbury (c.salisbury{at}, consultant senior lecturera
  1. a Division of Primary Health Care, University of Bristol, Bristol BS6 6JL
  2. b Faculty of Health and Social Care, University of West of England, Bristol BS16 1DD
  1. Correspondence to: C Salisbury
  • Accepted 11 March 2002


Objective: To determine whether nurse practitioners can provide care at first point of contact equivalent to doctors in a primary care setting.

Design: Systematic review of randomised controlled trials and prospective observational studies.

Data sources: Cochrane controlled trials register, specialist register of trials maintained by Cochrane Effective Practice and Organisation of Care Group, Medline, Embase, CINAHL, science citation index, database of abstracts of reviews of effectiveness, national research register, hand searches, and published bibliographies.

Included studies: Randomised controlled trials and prospective observational studies comparing nurse practitioners and doctors providing care at first point of contact for patients with undifferentiated health problems in a primary care setting and providing data on one or more of the following outcomes: patient satisfaction, health status, costs, and process of care.

Results: 11 trials and 23 observational studies met all the inclusion criteria. Patients were more satisfied with care by a nurse practitioner (standardised mean difference 0.27, 95% confidence interval 0.07 to 0.47). No differences in health status were found. Nurse practitioners had longer consultations (weighted mean difference 3.67 minutes, 2.05 to 5.29) and made more investigations (odds ratio 1.22, 1.02 to 1.46) than did doctors. No differences were found in prescriptions, return consultations, or referrals. Quality of care was in some ways better for nurse practitioner consultations. Embedded Image

Conclusion: Increasing availability of nurse practitioners in primary care is likely to lead to high levels of patient satisfaction and high quality care.

What is already known on this topic

What is already known on this topic Nurse practitioners have existed in North America for many years

An increasing number of such nurses are being employed in the United Kingdom in general practice, emergency departments, and other primary care settings

Reviews suggest that nurse practitioners are equivalent to doctors on most variables studied, but the relevance of this in the context of the NHS is unclear

What this study adds

What this study adds Patients are more satisfied with care from a nurse practitioner than from a doctor, with no difference in health outcomes

Nurse practitioners provide longer consultations and carry out more investigations than doctors

Most recent research has related to patients requesting same day appointments for minor illness, which is only a limited part of a doctor's role


  • Funding South and West Research and Development Directorate. The views expressed are those of the authors and not necessarily those of the NHS Executive South West.

  • Competing interests None declared.

  • Additional tables and references appear on

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