General medical services by non-medical health professionals: a systematic quantitative review of economic evaluations in primary care
Open accessAbstract
Background: Previous systematic reviews have found that nurses and pharmacists can provide equivalent, or higher, quality of care for some tasks performed by GPs in primary care. There is a lack of economic evidence for this substitution. Aim: To explore the costs and outcomes of role substitution between GPs and nurses, pharmacists, and allied health professionals in primary care. Design and setting: A systematic review of economic evaluations exploring role substitution of allied health professionals in primary care was conducted. Role substitution was defined as ‘the substitution of work that was previously completed by a GP in the past and is now completed by a nurse or allied health professional’. Method: The following databases were searched: Ovid MEDLINE, CINAHL, Cochrane Library, National Institute for Health and Care Excellence (NICE), and the Centre for Reviews and Dissemination. The review followed guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Six economic evaluations were identified. There was some limited evidence that nurse-led care for common minor health problems was cost-effective compared with GP care, and that nurse-led interventions for chronic fatigue syndrome and pharmacy-led services for the medicines management of coronary heart disease and chronic pain were not. In South Korea, community health practitioners delivered primary care services for half the cost of physicians. The review did not identify studies for other allied health professionals such as physiotherapists and occupational therapists. Conclusion: There is limited economic evidence for role substitution in primary care; more economic evaluations are needed.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 [39]
The Discussion Summary (page not provided) reports lower costs for nurse-led care of minor conditions, supporting that part of the claim. But it also reports higher costs for nurse-led heart-disease prevention and chronic-fatigue interventions, so this review does not support describing nurse-led services as generally similar or marginally cheaper. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823 · see citing works
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042 · see citing works
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859 · see citing works
Wang, G., Ma, R., Qiao, G., Wada, K., Aizawa, Y., & Satoh, T. (2015) · Integrative Medicine International · doi:10.1159/000368408 · Cited by 18,759 · see citing works
Methods for the Economic Evaluation of Health Care Programmes
Drummond, M. E., Sculpher, M. J., Torrance, G. W., O’Brien, B. J., & Stoddart, G. L. (2005) · doi:10.1093/oso/9780198529446.001.0001 · Cited by 13,648 · see citing works
Horrocks, S., Anderson, E., & Salisbury, C. (2002) · BMJ · doi:10.1136/bmj.324.7341.819 · Cited by 1,235 · see citing works
Substitution of doctors by nurses in primary care
Laurant, M. G. H., Reeves, D., Hermens, R., Braspenning, J., Grol, R. P. T. M., & Sibbald, B. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001271.pub2 · Cited by 961 · see citing works
US Pharmacists' Effect as Team Members on Patient Care: Systematic Review and Meta-Analyses
Chisholm-Burns, M. A., Kim Lee, J., Spivey, C. A., Slack, M., Herrier, R. N., Hall-Lipsy, E., Graff Zivin, J., Abraham, I., Palmer, J., Martin, J. R., et al. (2010) · Medical Care · doi:10.1097/mlr.0b013e3181e57962 · Cited by 809 · see citing works
Economic evaluation alongside randomised controlled trials: design, conduct, analysis, and reporting
Petrou, S., & Gray, A. (2011) · British medical journal · doi:10.1136/bmj.d1548 · Cited by 313 · 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
Are pharmacy-based minor ailment schemes a substitute for other service providers?
Paudyal, V., Watson, M. C., Sach, T., Porteous, T., Bond, C. M., Wright, D. J., Cleland, J., Barton, G., & Holland, R. (2013) · British Journal of General Practice · doi:10.3399/bjgp13x669194 · Cited by 143 · see citing works
The Community Pharmacy Medicines Management Project Evaluation Team (2007) · Family Practice · doi:10.1093/fampra/cml075 · Cited by 114 · see citing works
Nurse versus physician-led care for the management of asthma
Kuethe, M. C., Vaessen-Verberne, A. A. P. H., Elbers, R. G., & van Aalderen, W. M. C. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009296.pub2 · Cited by 66 · 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
Turner, D. A., Paul, S. K., Stone, M. A., Juarez-Garcia, A., Squire, I. B., & Khunti, K. K. (2008) · Heart · doi:10.1136/hrt.2007.125708 · Cited by 53 · see citing works
The effect of physician-nurse substitution in primary care in chronic diseases: a systematic review
Martínez-González, N. A., Rosemann, T. J., Tandjung, R., & Djalali, S. (2015) · Swiss Medical Weekly · doi:10.4414/smw.2015.14031 · Cited by 52 · see citing works
Neilson, A. R., Bruhn, H., Bond, C. M., Elliott, A. M., Smith, B. H., Hannaford, P. C., Holland, R., Lee, A. J., Watson, M. C., Wright, D. J., et al. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-006874 · Cited by 34 · see citing works
Daele, A. T. M. D.-V., Spreeuwenberg, C., Derckx, E. W., Metsemakers, J. F. M., & Vrijhoef, H. J. (2008) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2008.00924.x · Cited by 26 · see citing works
Cost-effectiveness of supported self-management for CFS/ME patients in primary care
Richardson, G. A., Epstein, D. M., Chew-Graham, C. A., Dowrick, C. F., Bentall, R. P., Morriss, R. K., Peters, S., Riste, L., Lovell, K., Dunn, G., et al. (2013) · BMC Family Practice · doi:10.1186/1471-2296-14-12 · Cited by 19 · see citing works
Is an expanded nurse role economically viable?
Lee, T. W., Ko, I. S., & Jeong, S. H. (2004) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2004.03021.x · Cited by 10 · see citing works
Flagged first, then by citations
1 of the 21 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Hayhoe B, Majeed A, Hamlyn M, Sinha M. Primary care workforce crisis: how many more GPs do we need? Presented at RCGP Annual Conference, Harrogate, 2016.
Cited by
Sorted by citations
Task shifting in primary care to tackle healthcare worker shortages: An umbrella review
Leong, S. L., Teoh, S. L., Fun, W. H., & Lee, S. W. H. (2021) · European Journal of General Practice · doi:10.1080/13814788.2021.1954616 · Cited by 228 · see citing works
Scale, scope and impact of skill mix change in primary care in England: a mixed-methods study
McDermott, I., Spooner, S., Goff, M., Gibson, J., Dalgarno, E., Francetic, I. N. ;., Hann, M., Hodgson, D. E., McBride, A., Checkland, K., et al. (2022) · Health and Social Care Delivery Research · doi:10.3310/ywtu6690 · Cited by 50 · see citing works
Identifying how GPs spend their time and the obstacles they face: a mixed-methods study
Sinnott, C., Moxey, J. M., Marjanovic, S., Leach, B., Hocking, L., Ball, S., Georgiadis, A., Lamé, G., Willars, J., & Dixon‐Woods, M. (2021) · British Journal of General Practice · doi:10.3399/bjgp.2021.0357 · Cited by 43 · see citing works
Gibson, J., Francetic, I., Spooner, S., Checkland, K., & Sutton, M. (2022) · The British journal of general practice : the journal of the Royal College of General Practitioners · doi:10.3399/bjgp.2021.0593 · Cited by 19 · see citing works
Effects of task-shifting from primary care physicians to nurses: an overview of systematic reviews
Paier-Abuzahra, M., Posch, N., Jeitler, K., Semlitsch, T., Radl-Karimi, C., Spary-Kainz, U., Horvath, K., & Siebenhofer, A. (2024) · Human Resources for Health · doi:10.1186/s12960-024-00956-3 · Cited by 29 · see citing works
Identifying how GPs spend their time and the obstacles they face: a mixed-methods study.Preprint
Sinnott, C., Moxey, J. M., Marjanovic, S., Leach, B., Hocking, L., Ball, S., Georgiadis, A., Lamé, G., Willars, J., & Dixon‐Woods, M. (2021) · RePEc: Research Papers in Economics · doi:10.17863/cam.76049 · Cited by 28 · see citing works
A comparative case study of prescribing and non-prescribing physiotherapists and podiatrists
Carey, N., Edwards, J., Otter, S. J., Gage, H., Williams, P., Courtenay, M., Moore, A. P., & Stenner, K. L. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-05918-8 · Cited by 22 · see citing works
Broadening the scope of task shifting in the organisation of healthcare
van Tuyl, L. H. D., Vrijhoef, H. J., Laurant, M. G. H., Bont, A. A. D., & Batenburg, R. S. (2021) · International Journal of Care Coordination · doi:10.1177/20534345211039988 · Cited by 19 · see citing works
Hutchinson, J., Lau, Y., Sutton, M., & Checkland, K. (2023) · British Journal of General Practice · doi:10.3399/bjgp.2023.0007 · Cited by 17 · see citing works
Casey, M., O’Connor, L., Rohde, D., Twomey, L., Cullen, W., & Carroll, Á. M. (2022) · Health Science Reports · doi:10.1002/hsr2.555 · Cited by 15 · see citing works
Development of a primary care pharmacy outcomes framework: An umbrella literature review
Weir, N., Preston, K., Newham, R., & Bennie, M. (2021) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2021.07.010 · Cited by 14 · see citing works
Economic evaluation of patient direct access to NHS physiotherapy services
Yang, M., Bishop, A., Sussex, J., Roland, M. O., Jowett, S. M., & Wilson, E. (2021) · Physiotherapy · doi:10.1016/j.physio.2020.12.005 · Cited by 14 · see citing works
Advanced Practice Providers in Plastic Surgery
Seyidova, N., Chen, A. D., Lee, J., Alnaeem, H., Grover, R., & Lin, S. J. (2021) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000007877 · Cited by 13 · see citing works
Understanding key factors for strengthening Nepal’s healthcare needs: health systems perspectives
Dumka, N., Gurung, A., Hannah, E., Goel, S., & Kotwal, A. (2024) · Journal of Global Health Reports · doi:10.29392/001c.94931 · Cited by 13 · see citing works
Khanday, I. N., & Tarique, M. (2023) · The Journal of Economic Asymmetries · doi:10.1016/j.jeca.2023.e00341 · Cited by 15 · see citing works
Looi, J. C., Allison, S. C., Bastiampillai, T. J., Hensher, M., Kisely, S. R., & Robson, S. (2024) · Australasian Psychiatry · doi:10.1177/10398562241267138 · Cited by 11 · see citing works
Elmansouri, A., Curtis, S., Nursaw, C., & Smith, D. (2023) · BMC Medical Education · doi:10.1186/s12909-023-04179-3 · 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
Consultation With Nurse Practitioners Over the Telephone in Prison Health
Schoenwald, A., Ponting, B., How, R., Mansfield, Y., & Meehan, T. (2022) · The Journal for Nurse Practitioners · doi:10.1016/j.nurpra.2021.12.011 · Cited by 4 · see citing works
Booker, M. J., Voss, S. E., Harris, N., Hollingworth, W., Gadah-Jeynes, N. S., Taylor, H., Garfield, K., Baxter, H., Benger, J. R., Gibson, A., et al. (2025) · Health and Social Care Delivery Research · doi:10.3310/gtjj3104 · Cited by 1 · see citing works
Carey, N., Edwards, J., Otter, S. J., Gage, H., Williams, P., Courtenay, M., Moore, A. P., & Stenner, K. L. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.01.09.900043 · Cited by 1 · see citing works
Survey of Actual Conditions of Nursing Practice in Outpatient Cancer Nursing in Japan
Iioka, Y., MINEKAWA, M., & Suzuki, K. (2022) · Journal of Japan Academy of Nursing Science · doi:10.5630/jans.42.706
Morgner, J., Heise, M., Wiens, C., Bauch, F., Wienke, A., Frese, T., & Weise, S. (2025) · Family Medicine and Community Health · doi:10.1136/fmch-2025-003627
Elmansouri, A., Curtis, S., Nursaw, C., & Smith, D. (2024) · Figshare · doi:10.6084/m9.figshare.26586297
- Authors
- Anthony, B. F., Surgey, A., Hiscock, J., Williams, N. H., & Charles, J. M.
- Affiliations
- University of Liverpool (GB)
- Bangor University (GB)
- Venue
- British Journal of General Practice
- Published
- 2019-04-23
- Volume
- 69
- Issue
- 682
- Pages
- e304-e313
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC6478480
- OpenAlex
- W2942368822
- Cited by
- 24
- References
- 21
- Citations by year
- 2025: 2 · 2024: 5 · 2023: 3 · 2022: 5 · 2021: 7 · 2020: 2
- FWCI
- 4.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Bangor University Research Portal (Bangor University) (submittedVersion, other-oa)
- Funders
- Health and Care Research Wales (HS-16-31)
- Bangor University
- 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
- role substitution, non-medical health professionals, nurse-led care, pharmacist-led services, allied health professionals, general practitioners, primary care, cost-effectiveness, chronic fatigue syndrome, coronary artery disease, chronic pain, community health practitioners, South Korea
- MeSH terms
- Allied Health Personnel, Cost-Benefit Analysis, Humans, Nurse Practitioners, Pharmacists, Primary Health Care, Professional Role, General Practitioners
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
