Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors
Open accessAbstract
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. 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: 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: 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
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Many studies with strong research designs have shown nursing-intensive primary care models to be safe and effective.
“Many studies with strong research designs have shown nursing-intensive primary care models to be safe and effective.8,11,18-26”
From Evaluating the cost of NP-led vs. GP-led primary care in British Columbia (2024) · cites this paper as [19]
The Results report 11 randomised trials and 23 observational studies, and the Discussion finds similar health outcomes and care quality for nurse practitioners compared with doctors. But the Discussion says no study was adequately powered to detect rare, serious adverse outcomes, and the Conclusion calls for further research to confirm safety. The source therefore supports evidence of effectiveness in the care studied, not an unqualified finding that these models are safe. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMeasurable clinical outcomes are systematically found to be equivalent to those produced by medical models, though patient satisfaction tends to be higher for nurse-provided services.
“Measurable clinical outcomes are systematically found to be equivalent11,18,19,23,27-32 to those produced by medical models, though patient satisfaction tends to be higher for nurse-provided services.11,19,21,26,27,29,30,33,34”
From Evaluating the cost of NP-led vs. GP-led primary care in British Columbia (2024) · cites this paper as [19]
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Cites
Assessing the quality of controlled clinical trials
Jüni, P., Altman, D. G., & Egger, M. (2001) · BMJ · doi:10.1136/bmj.323.7303.42 · Cited by 3,309 · see citing works
Systematic Reviews in Health Care : Meta-Analysis in Context
Egger, M., Smith, G. D., & Altman, D. G. (2000) · Cited by 2,312 · see citing works
Systematic Reviews in Health Care. Meta-analysis in Context.
Kleijnen, J., & Antes, G. (2002) · International Journal of Epidemiology · doi:10.1093/ije/31.3.697 · Cited by 1,373 · see citing works
Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A Randomized Trial
Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W.-Y., Cleary, P. D., Friedewald, W. T., Siu, A. L., & Shelanski, M. L. (2000) · JAMA · doi:10.1001/jama.283.1.59 · Cited by 955 · see citing works
Dixon, J. (2000) · BMJ · doi:10.1136/bmj.321.7257.315 · Cited by 953 · see citing works
Venning, P. (2000) · BMJ · doi:10.1136/bmj.320.7241.1048 · Cited by 494 · see citing works
The Burlington Randomized Trial of the Nurse Practitioner
Spitzer, W. O., Sackett, D. L., Sibley, J. C., Roberts, R. S., Gent, M., Kergin, D. J., Hackett, B. C., Olynich, A., Hay, W. I., Lefroy, G., et al. (1974) · New England Journal of Medicine · doi:10.1056/nejm197401312900506 · Cited by 432 · see citing works
Kinnersley, P. (2000) · BMJ · doi:10.1136/bmj.320.7241.1043 · Cited by 428 · see citing works
A Meta-Analysis of Nurse Practitioners and Nurse Midwives in Primary Care
Brown, S. A., & Grimes, D. E. (1995) · Nursing Research · doi:10.1097/00006199-199511000-00003 · Cited by 326 · see citing works
Shum, C. (2000) · BMJ · doi:10.1136/bmj.320.7241.1038 · Cited by 289 · see citing works
Sakr, M., Angus, J., Perrin, J., et al. (1999) · The Lancet · doi:10.1016/s0140-6736(99)02447-2 · Cited by 257 · see citing works
The Burlington Randomized Trial of the Nurse Practitioner: Health Outcomes of Patients
Sackett, D. L., SPITZER, W. O., GENT, M., et al. (1974) · Annals of Internal Medicine · doi:10.7326/0003-4819-80-2-137 · Cited by 196 · see citing works
Quality of Patient Care by Nurse Practitioners and Physician's Assistants: A Ten-Year Perspective
Sox, H. C. (1979) · Annals of Internal Medicine · doi:10.7326/0003-4819-91-3-459 · Cited by 171 · see citing works
Roberts-Davis, M., & Read, S. M. (2001) · Journal of Clinical Nursing · doi:10.1046/j.1365-2702.2001.00437.x · Cited by 103 · see citing works
Nurse practitioners in primary care
Offredy, M. (2000) · Family Practice · doi:10.1093/fampra/17.6.564 · Cited by 101 · see citing works
What Constitutes Adequate Well-Baby Care?
Hoekelman, R. A., DeCancq, H. G., Fox, M., McAnarney, E., O'Brien, B., Olin, C., Perrin, E., Porter, C., Samuelson, C., & Stutzman, H. (1975) · PEDIATRICS · doi:10.1542/peds.55.3.313 · Cited by 65 · see citing works
Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A Randomized Trial
Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W., Cleary, P. D., Friedewald, W. T., Sui, A. L., & Shelanski, M. L. (2000) · Survey of Anesthesiology · doi:10.1097/00132586-200012000-00026 · Cited by 57 · see citing works
Collaborative practice and provider styles of delivering health care
Campbell, J. D., Mauksch, H. O., Neikirk, H. J., & Hosokawa, M. C. (1990) · Social Science & Medicine · doi:10.1016/0277-9536(90)90316-k · Cited by 45 · see citing works
Economic approaches to doctor/nurse skill mix: problems, pitfalls, and partial solutions.
Kernick, D. P., & Scott, A. (2002) · PubMed · Cited by 35 · see citing works
The St John's Randomized Trial of the Family Practice Nurse: Health Outcomes of Patients
Chambers, L. W., & WEST, A. E. (1978) · International Journal of Epidemiology · doi:10.1093/ije/7.2.153 · Cited by 34 · see citing works
Primary care outcomes in patients treated by nurse practitioners or physicians. A randomized trial.
Wardrope, J., & Rothwell, S. (2000) · PubMed · Cited by 32 · see citing works
Well-Child Care by Pediatric Nurse Practitioners in a Large Group Practice
Burnip, R. (1976) · American journal of diseases of children · doi:10.1001/archpedi.1976.02120020053008 · Cited by 18 · see citing works
Skill Mix in Primary Care - a bibliography.
Sergison, M., Bs, S., & Rose, S. (1997) · OpenGrey (Institut de l'Information Scientifique et Technique) · Cited by 16 · see citing works
A Delphi survey to identify activities of nurse practitioners in primary care.
Lo, H. (2000) · PubMed · Cited by 15 · see citing works
Nurse Practitioners in Primary Care
Wartman, S. A. (1994) · New England Journal of Medicine · doi:10.1056/nejm199405263302116 · Cited by 2 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Winter C. Quality health care: patient assessment. MSc thesis. Long Beach, CA: California State University, 1981.
Cited by
Sorted by citations
Nurses as substitutes for doctors in primary care
Laurant, M., van der Biezen, M., Wijers, N., Watananirun, K., Kontopantelis, E., & van Vught, A. J. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001271.pub3 · Cited by 614 · see citing works
Substitution of physicians by nurses in primary care: a systematic review and meta-analysis
Martínez-González, N. A., Djalali, S., Tandjung, R., Huber-Geismann, F., Markun, S., Wensing, M., & Rosemann, T. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-214 · Cited by 310 · see citing works
Lau, R., Stevenson, F., Ong, B. N., Dziedzic, K., Treweek, S., Eldridge, S., Everitt, H., Kennedy, A., Qureshi, N., Rogers, A., et al. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-009993 · Cited by 254 · see citing works
“28 61 69 78 83 84 In general, these reviews demonstrated an improvement in process of care outcomes.”
BackgroundMartin-Misener, R., Harbman, P., Donald, F., Reid, K., Kilpatrick, K., Carter, N., Bryant-Lukosius, D., Kaasalainen, S., Marshall, D. A., Charbonneau-Smith, R., et al. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-007167 · Cited by 252 · see citing works
Smith, R. C., Lyles, J. S., Gardiner, J. C., Sirbu, C., Hodges, A., Collins, C., Dwamena, F. C., Lein, C., Given, C. W., Given, B., et al. (2006) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2006.00460.x · Cited by 187 · see citing works
Charlton, C. R., Dearing, K. S., Berry, J. A., & Johnson, M. J. (2008) · Journal of the American Academy of Nurse Practitioners · doi:10.1111/j.1745-7599.2008.00336.x · Cited by 173 · see citing works
Nurse practitioners substituting for general practitioners: randomized controlled trial
Dierick‐van Daele, A. T. M., Metsemakers, J. F. M., Derckx, E. W. C. C., Spreeuwenberg, C., & Vrijhoef, H. J. M. (2009) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2008.04888.x · Cited by 170 · see citing works
Randall, S., Crawford, T., Currie, J., River, J., & Betihavas, V. (2017) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2017.05.008 · Cited by 167 · see citing works
The Impact of Nonphysician Clinicians
Laurant, M., Harmsen, M., Wollersheim, H., Grol, R., Faber, M., & Sibbald, B. (2009) · Medical Care Research and Review · doi:10.1177/1077558709346277 · Cited by 166 · see citing works
Bonsall, K., & Cheater, F. M. (2008) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2007.07.013 · Cited by 145 · see citing works
Mdege, N. D., Chindove, S., & Ali, S. (2013) · Health Policy and Planning · doi:10.1093/heapol/czs058 · Cited by 137 · see citing works
Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care
Liu, C., Hebert, P. L., Douglas, J. H., Neely, E. L., Sulc, C. A., Reddy, A., Sales, A. E., & Wong, E. S. (2020) · Health Services Research · doi:10.1111/1475-6773.13246 · Cited by 121 · see citing works
Use of Midlevel Practitioners to Achieve Labor Cost Savings in the Primary Care Practice of an MCO
Roblin, D. W., Howard, D. H., Becker, E. R., Kathleen Adams, E., & Roberts, M. H. (2004) · Health Services Research · doi:10.1111/j.1475-6773.2004.00247.x · Cited by 114 · see citing works
Effectiveness of nurse-delivered cardiovascular risk management in primary care: a randomised trial
Voogdt-Pruis, H. R., Beusmans, G. H., Gorgels, A. P., Kester, A. D., & Van Ree, J. W. (2010) · British Journal of General Practice · doi:10.3399/bjgp10x482095 · Cited by 114 · see citing works
Lovink, M. H., Persoon, A., Koopmans, R. T. C. M., Van Vught, A. J. A. H., Schoonhoven, L., & Laurant, M. G. H. (2017) · Journal of Advanced Nursing · doi:10.1111/jan.13299 · Cited by 83 · see citing works
Costs and effects of new professional roles: Evidence from a literature review
Tsiachristas, A., Wallenburg, I., Bond, C. M., Elliot, R. F., Busse, R., van Exel, J., Rutten-van Mölken, M. P., & de Bont, A. (2015) · Health Policy · doi:10.1016/j.healthpol.2015.04.001 · Cited by 90 · see citing works
Poghosyan, L., Liu, J., & Norful, A. A. (2017) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2017.05.004 · Cited by 74 · see citing works
Hoare, K. J., Mills, J., & Francis, K. (2012) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2011.05870.x · Cited by 77 · see citing works
Economic evaluation of nurse practitioners versus GPs in treating common conditions
Dierick-van Daele, A. T., Steuten, L. M., Metsemakers, J. F., Derckx, E. W., Spreeuwenberg, C., & Vrijhoef, H. J. (2010) · British Journal of General Practice · doi:10.3399/bjgp10x482077 · Cited by 62 · see citing works
Martínez-González, N. A., Rosemann, T., Djalali, S., Huber-Geismann, F., & Tandjung, R. (2015) · Medical Care Research and Review · doi:10.1177/1077558715586297 · Cited by 60 · see citing works
Anthony, B. F., Surgey, A., Hiscock, J., Williams, N. H., & Charles, J. M. (2019) · British Journal of General Practice · doi:10.3399/bjgp19x702425 · Cited by 24 · see citing works
A model of succession planning for mental health nurse practitioners
Hampel, S., Procter, N., & Deuter, K. (2010) · International Journal of Mental Health Nursing · doi:10.1111/j.1447-0349.2010.00668.x · Cited by 23 · see citing works
Liddy, C., Deri Armstrong, C., McKellips, F., & Keely, E. (2016) · Journal of the American Association of Nurse Practitioners · doi:10.1002/2327-6924.12266 · Cited by 20 · see citing works
Uppal, S., Nadig, S., Smith, L., & Coatesworth, A. (2004) · Annals of The Royal College of Surgeons of England · doi:10.1308/147870804515 · Cited by 14 · see citing works
Advanced practice nurses led clinic in a psychiatric hospital: An outcome evaluation in Singapore
Xu, C., Xie, H., Zhou, Z., Govindasamy, A., Mao, R., & Chan, Y. H. (2020) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2020.03.003 · Cited by 10 · see citing works
Menezes, P. R., Araya, R., Miranda, J., Mohr, D. C., & Price, L. N. (2015) · Revista de la Facultad de Ciencias Médicas de Córdoba · doi:10.31053/1853.0605.v72.n4.13842 · Cited by 10 · see citing works
Evaluating the cost of NP-led vs. GP-led primary care in British Columbia
Contandriopoulos, D., Bertoni, K., McCracken, R., Hedden, L., Lavergne, R., & Randhawa, G. K. (2024) · Healthcare Management Forum · doi:10.1177/08404704241229075 · Cited by 5 · see citing works
“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
- Horrocks, S., Anderson, E., & Salisbury, C.
- Affiliations
- University of Bristol (GB)
- University of the West of England (GB)
- Corresponding author
- Horrocks, Sue
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2002-04-06
- Volume
- 324
- Issue
- 7341
- Pages
- 819-823
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- PMC
- PMC100791
- OpenAlex
- W2155306033
- Cited by
- 1,235
- References
- 25
- Citations by year
- 2026: 8 · 2025: 26 · 2024: 37 · 2023: 18 · 2022: 28 · 2021: 40 · 2020: 41 · 2019: 37 · 2018: 47 · 2017: 73 · 2016: 50 · 2015: 73 · 2014: 69 · 2013: 71 · 2012: 61
- FWCI
- 14.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed (publishedVersion)
- UWE Research Repository (UWE Bristol) (submittedVersion, cc-by)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Health Professions › General Health Professions › Interprofessional Education and Collaboration
- Keywords
- nurse practitioners, primary care, patient satisfaction, health status outcomes, consultation time, diagnostic workup, quality of care, health care costs, same-day appointments, minor illness, general practice
- MeSH terms
- Workforce, Clinical Competence, Humans, Nurse Practitioners, Primary Health Care, Prospective Studies, Quality of Health Care, Clinical Nursing Research, Randomized Controlled Trials as Topic, Patient Satisfaction
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