A nurse practitioner as the first point of contact for urgent medical problems in a general practice setting

The aim of this study was to examine the suitability of nurse practitioners for assessing and managing urgent clinical problems presenting in primary care.

Patients registered at a suburban group practice presenting with acute medical problems were offered the choice of seeing a GP or a nurse practitioner. The outcomes of 1000 consultations were analysed by recording the repeat consultation rate, the prescription-issue rate and the rate of referral to secondary care, as well as investigating patient satisfaction and the number of dysfunctional consultations and misdiagnoses.

Patients reported a high level of satisfaction with nurse practitioner consultations, and there were no recorded instances of medical sequelae due to poor diagnosis or mismanagement. Nurse and doctors saw patients with similar age and sex distributions, but the results suggested that there was a significant difference between the morbidity of problems seen. There was also a difference in the outcomes of repeat consultation rate and the prescription issue rate, although there was little difference in the rate of referral for secondary care.

As patients expressed a high level of satisfaction with the nurse practitioner, this suggests that given the choice, patients in primary care can safely and effectively 'self triage' themselves between GPs and nurse practitioners.