Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care
Open accessAbstract
OBJECTIVE: To compare the cost effectiveness of general practitioners and nurse practitioners as first point of contact in primary care. DESIGN: Multicentre randomised controlled trial of patients requesting an appointment the same day. SETTING: 20 general practices in England and Wales. PARTICIPANTS: 1716 patients were eligible for randomisation, of whom 1316 agreed to randomisation and 1303 subsequently attended the clinic. Data were available for analysis on 1292 patients (651 general practitioner consultations and 641 nurse practitioner consultations). MAIN OUTCOME MEASURES: Consultation process (length of consultation, examinations, prescriptions, referrals), patient satisfaction, health status, return clinic visits over two weeks, and costs. RESULTS: Nurse practitioner consultations were significantly longer 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; odds ratio 1.66, 95% confidence interval 1.04 to 2.66) and asked patients to return more often (37. 2% v 24.8%; 1.93, 1.36 to 2.73). There was no significant difference in patterns of prescribing or health status outcome for the two groups. Patients were more satisfied with nurse practitioner consultations (mean score 4.40 v 4.24 for general practitioners; adjusted difference 0.18, 0.092 to 0.257). This difference remained after consultation length was controlled for. There was no significant difference in health service costs (nurse practitioner 18.ll pound sterling v general practitioner 20.70 pound sterling adjusted difference 2.33 pound sterling - 1.62 pound sterling to 6.28 pound sterling). CONCLUSIONS: The clinical care an health service costs of nurse practitioners and general practitioners were similar. If nurse practitioners were able to maintain the benefits while reducing their return consultation rate or shortening consultation times, they could be more cost effective than general practitioners.
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The literature generally reports similar or marginally lower costs for nurse-led services.
“This literature generally reports similar27,34-37 or marginally lower29,38-41 costs for nurse-led services.”
From Evaluating the cost of NP-led vs. GP-led primary care in British Columbia (2024) · cites this paper as [34]
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“11,19,21,26,27,29,30,33,34 There also are some robust studies comparing the cost of care provided by nurses — generally NPs — to the cost of care provided by physicians.”
Background
- Authors
- Venning, P.
- Affiliations
- University of Manchester (GB)
- Corresponding author
- Venning, P
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2000-04-15
- Volume
- 320
- Issue
- 7241
- Pages
- 1048-1053
- ISSN
- 0959-8138 (ISSN-L)
- PMC
- PMC27348
- OpenAlex
- W2139063638
- Cited by
- 494
- References
- 17
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 8 · 2023: 4 · 2022: 3 · 2021: 13 · 2020: 16 · 2019: 8 · 2018: 19 · 2017: 20 · 2016: 17 · 2015: 29 · 2014: 19 · 2013: 25 · 2012: 11
- FWCI
- 66.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Office of Research and Development
- Wellcome Trust (045384)
- Topics
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- nurse practitioners, general practitioners, cost-effectiveness, primary care, same-day appointments, consultation time, patient satisfaction, return visits, drug prescribing, health care costs, nurse-led primary care
- MeSH terms
- Adolescent, Adult, Aged, Child, Child, Preschool, Cost-Benefit Analysis, England, Family Practice, Humans, Infant, Infant, Newborn, Middle Aged, Nurse Practitioners, Patient Acceptance of Health Care, Practice Patterns, Physicians', Professional Practice, Recurrence, Referral and Consultation, Time Factors, Wales, Patient Satisfaction
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