Comparing costs

The article comparing nurse practitioner (NP) and GP cost in the July issue of the journal¹ is timely as my practice is considering this choice to balance our primary healthcare team. Several issues remain unanswered however:

1. What sort of clinical problems are managed by the NP and GP?

   Nurses skilled in chronic diseasemanagement areas are experts in their own field, as are nurses triaging acute diseases ‘booked on the day’. But it is rare to find a nurse with knowledge and experience in all clinical areas.

2. Patient satisfaction will depend on the ease of booking, the process during and the end result of the consultation.

   Patients may self-select their practitioner for problems with differing complexity. Satisfaction may be easier to achieve if the problem is easy to identify and self limiting.

3. Cross referral within an established multidisciplinary team may result in achieving the best of both worlds.

   Patients may be offered an initial assessment by GP or NP and then a three way discussion about the best option for the patient, combining the strengths of all concerned to achieve the best possible result and avoiding unnecessary investigation.