Substitution of general practitioners by nurse practitioners in out-of-hours primary care: a quasi experimental study

Aim : To provide insight into the impact of substituting general practitioners with nurse practitioners in out-of-hours services on (1) the number of patients, and (2) general practitioners’ caseload (patient characteristics, urgency levels, types of complaints). Background: General practitioners’ workload during out-of-hours care is high, the number of hours they work out-of-hours has increased, which raises concerns about maintaining quality of care. One response to these challenges is shifting care to nurse practitioners. Design: Quasi-experimental study comparing differences between and within out-of-hours teams; experimental: 1 nurse practitioner and 4 general practitioners; control: 5 general practitioners. Methods: Data of 12,092 patients from one general practitioner cooperative were extracted from medical records between April 2011 and July 2012. Results: The number of patients was similar in the two study arms. In the experimental arm the nurse practitioner saw on average 16.3% of the patients and each general practitioner on average 20.9% of the patients. General practitioners treated more: older patients; higher urgency levels; and digestive, cardiovascular, and neurological complaints. Nurse practitioners treated more patients with skin and respiratory complaints . Substitution did not lead to a meaningful increase of general practitioners’ caseload. Conclusion: The results show that NPs can have a valuable contribution to patient care during out-of-hours. The patients managed and care provided by NPs is roughly the same as GPs’. In areas with a shortage of GPs, administrators could consider to introduce qualified nurses who are competent to independently treat patients with a broad range of complaints to offer timely care to patients with acute problems.