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Why I'm dispirited by being 'fallow'

GP consultations cost less than those by nurse practitioners, new research shows.

A study by academics at the University of Bristol puts the average cost to practices of a nurse practitioner consultation at £9.46, in terms of salary costs, compared with £9.30 for a GP.

From the perspective of the NHS ­ taking into account training, treatment and prescription costs ­ a nurse practitioner consultation costs £30.35, compared with £28.14 for a GP.

GPC chair Dr Hamish Meldrum said the results, being published in a conference supplement in the journal Family Practice in July, added weight to arguments that the Government should focus on recruiting GPs rather than developing other health care professionals.

'The balance of the skill mix is not right,' he said.

'If you look at NHS Direct and out-of-hours services they are more nurse led but this is not necessarily the most cost-effective way.'

Dr Sarah Jarvis, RCGP medical practices committee member and a GP in west London, said the findings backed previous research that suggested nurse practitioners referred, prescribed, investigated and recalled patients more than GPs.

'There has never been a great deal of hard evidence for nurse practitioners being more cost-effective than GPs,' she said.

She said the development of skill mix was effectively a knee-jerk reaction by ministers who had 'ignored' warnings in the 1990s that the GP recruitment crisis was worsening.

Dr Dermott Ryan, a GP in Loughborough whose practice has had a nurse practitioner for the last 17 years, said he agreed with the findings.

He said nurses were best left to manage chronic diseases as they took longer to treat other patients.

'Nurses take two to three times longer because of their lack of expertise and so they will be more expensive,' he said.

But Dr James Kingsland, chair of the National Association for Primary Care, said nurse practitioners' efficiency was 'unquestionable'. He warned against using the research to imply GP-only health care teams were more effective.

He said: 'It rests on the right balance within the health care team.'

Benny Harston, chair of the Royal College of Nursing's Nurse Practitioner Association, said the findings were not comparing like with like.

'We are not doctor substitutes,' she said. 'Whether the nurse practitioner is cost-effective would be the same as for the GP ­ it depends on the person.'

By Joe Lepper

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