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GP practice nurses provide care 'as good as GPs', claims study

Care provided by practice nurses is as good as care provided by GPs and may even be better, according to a new review.

Nurse-led primary care may lead to improved mortality rates, blood pressure outcomes and patient satisfaction compared to GP-led care, according to the research.

A meta-analysis of the study results showed evidence for improved mortality in nurse-led care, with six in 1,000 patients dying under doctor-led care and between four and six per 1,000 dying under nurse-led care.

It also showed that blood pressure outcomes were slightly improved under nurse-led care, with practice nurses improving systolic blood pressure by just under 4mmHg, compared with GPs.

Patients were more likely to be satisfied with practice nurse care than GP care, although the difference between the two was marginal.

Practice nurse-led care was found to be just as good as GP-led care for other clinical outcomes, including controlling a patient’s HbA1c and cholesterol levels.

There was also no difference between practice nurses and GPs for patient-reported pain in those with rheumatoid arthritis.

The review was led by researchers in the Netherlands and looked at 18 studies investigating outcomes in nurse-led primary care based mostly in Europe and North America.

The authors pointed out that much of the evidence was of low-to-moderate certainty due to wide confidence intervals in the results and variation in the design of the studies.

They said in the paper: ‘This review shows that trained nurses, such as nurse practitioners, practice nurses, and registered nurses, probably provide care that is equal to or of better quality than that provided by primary care doctors, and probably achieve equal or better health outcomes for patients.

‘Although the included studies show effects of an independent practice role for nurses, it is likely that the quality of patient care overall is determined by overall functioning of the primary care team, including nurses, doctors, and other healthcare providers.

‘Policy makers should be aware that implementing nurse substitution in primary care teams may have an influence on the functioning and quality of care delivered by the entire care team.’

Cochrane Database Syst Rev 2018; online 16 Jul

A version of this article was first published by Pulse's sister title Nursing in Practice

Readers' comments (15)

  • Macaque

    Anecdotal but this is my experience as well.

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  • This is for ongoing care of a diagnosed condition. Noctors and proctors are not able to make a differential diagnosis when they are not even aware that diseases even exist.

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  • Are they preparing grounds for now nurse led Primary care because they can see that it will be impossible to fund GP lead primary health care?

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  • there are so many holes in this I don"t know where to start.

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  • Really!? Who comes up with this shit?

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  • I haven't got time to sit quietly for 5 mins then check a BP. (and nurses - brilliant though they are) don't get the list of 78 problems in 10 mins to sort.

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  • very interesting, if you live in Holland

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  • So we conclude that routine long term condition management is best done by practice nurses.

    Hardly revolutionary - this has been standard practice in the UK since at least 2004 when QOF arrived.

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  • Physios provide better care than oncologists 0 in 1000 compared to 100s in 1000 mortality. Absolute nonsense statistics.

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  • 'GP nurses provide care at least as good as GPs-for routine chronic disease work that GPs have delegated to them with protocols'
    There. Fixed that.

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