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Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7241.1048 (Published 15 April 2000) Cite this as: BMJ 2000;320:1048

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This study adds an uneven playing field.

What this study adds to the debate is that some 300 out of 1700 would
prefer not to see a nurse practitioner, if they are given the choice to
see a doctor. This flies mildly in the face of the assertion that
"patients react positively to use of nurse practitioners", under the
heading of "what we already know".

It has been pointed out before in the medical press that patients
agreeing to see a nurse practitioner the same day, versus seeing a GP
tomorrow or the day after, does not constitute either preference or
approval.

With the 300 patients opting out of possibly seeing a nurse rather
than a doctor, the patient sample has also been screened for patients who,
conceivably, might not be predisposed to giving nurse practitioner glowing
reviews.

A further 100 patients were not randomised to the study, likely
leaving a study group of patients with more straightforward complaints.
If this was the case, it would invalidate the comparison between GPs and
NPs.

It is not clear from the paper whether the cost comparison includes
costs of the higher number of return appointments arranged by nurse
practitioners.

The paper helpfully details nurse average length of qualified nursing
/ NP experience (quite mature nurse samples), but nothing was included
about average length of the doctors' post-qualification experience. Was
the writers of the paper stumbling over themselves to proclaim that NPs
are an experienced group of professionals? In isolation, it did not
contribute to the comparison.

The length of appointment bookings (as opposed to actual consultation
lengths) would have been useful to specify. Were the patients allocated
10-minute slots with both GPs and NPs? If NPs had 20-minute slots it
would leave much time for data entry, request form filling and general
tidying up between seeing patients.

My general impression of this paper is that it was not as objective
as I would like a paper to be, especially when dealing with an area where
financial interests may be in some conflict with safety concerns.

Competing interests:
I have no competing interests as I do not gain financially from employing nurse practitioners.

Competing interests: No competing interests

19 December 2005
Peter Ripley
GP Locum
Glasgow G78 1LN

Nurse Practitioners are an asset to private practice

I am really disappointed that this article was printed in this web site and with a very demeaning and misleading title which leads the reader to believe that this information can be extrapolated to our US society. This study was done in a society where the NP role is new...we here in the US have had NP's in practice since the mid 70's. I don't think a cross comparison can be made to US NP's yet I know certain MD's will use this against us anyway.

Why don't you all interview some MD's that work with NP's and do consider us cost effective and a viable extension to their practices.....I can give you two names of satisfied MD's which will argue the points made in your article. The only thing I think was a viable point in this study is the fact that it recognizes that patients are more satisfied with their care by NP's( verified by recent study in JAMA) and tho perhaps cost savings was not achieved in this particular study, quality care and patient satisfaction was achieved and in the long run that is what is most important!

Competing interests: No competing interests

28 April 2000
Diana S Look
Family Nurse Practitioner
work in Family practice sports medicine private practice with collaborative relationship with MD
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