The authors' discussion touches on the matter of economic justification. They mention that when the project was set up the cost-effectiveness of the alteration in practice was not considered. Indeed, I recall when the Trent Regional Audit for Surgery of the Hand visited Leicester, the Orthopaedic Business Manager mentioning that no business case had ever been put forward for this alteration in clinical practice – a most unusual situation in contemporary practice.
Senior experienced nurse practitioners are hopefully paid a salary commensurate with their experience. When I visited Leicester, my impression was that three or perhaps four patients were admitted by the nurse practitioner and then went forward with surgery in each operating session. A reasonably experienced trainee surgeon in our unit would likely do seven cases during an operating session. It may be that the throughput per list in Leicester has risen since our visit. Have the authors any data to offer concerning relative costs between carpal tunnel decompression performed by surgeons and those performed by nurse practitioners?