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Authors: Edwards, Martin¹; Bobb, Carol²; Robinson, Susan I³

Source: British Journal of General Practice, Volume 59, Number 558, January 2009 , pp. 7-11(5)

Abstract:

Background

GPs often perceive home-visit requests as a time-consuming aspect of general practice. The new general medical services contract provides for practices to be relieved of responsibility for home-visits, although there is no model for the transfer of care. One such model could be to employ nurse practitioners to manage such requests. Nurse practitioners can effectively substitute for GPs in managing same-day in-hours emergency care in the surgery, but their role in managing all such requests, including those requiring home visits, has not been assessed.

Aim

To explore the feasibility and clinical management outcomes of nurse practitioner management of same-day care requests, including those requiring home visits, to inform a proposed randomised controlled trial.

Design of study

Non-randomised comparative trial.

Setting

One large general practice (14 600 patients) in south London.

Method

Nurse practitioner assessment and management of all same-day care requests for 2 days per week was compared with normal GP management on another 2 days, over a 6-month period. Clinical management outcome data were collected from patient records and from data-collection forms completed by a nurse practitioner and GPs. Patient and staff satisfaction was assessed by questionnaire.

Results

The nurse practitioner was more likely than GPs to assess patients in person, less likely to give advice alone, and more likely to issue a prescription. There was no significant difference between the nurse practitioner and GPs regarding any other clinical management outcomes or patient satisfaction; however, the response rate of the patient satisfaction questionnaire in this pilot study was poor.

Conclusion

Nurse practitioner management of acute in-hours care requests, including home visits, appears feasible in practice and merits further assessment.

Keywords: house calls; nurse practitioners; primary health care

Document Type: Research article

DOI: 10.3399/bjgp09X394798

Affiliations: 1: Jenner Practice, Forest Hill, London 2: Kingston University Health Centre, Fairhill Medical Practice, Kingston-Upon-Thames, London 3: Lewisham Research Unit, Cantilever House, London

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