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Nurses as good as doctors in providing primary care

Nurses substituting for doctors in primary care achieve results that are as good or better, a review of trials shows

Nurses substituting for doctors in primary care achieve results that are as good or better, a review of trials shows


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In the face of changing populations, increased healthcare demands, workforce shortages and financial austerity, interest has grown in new models of primary care in which nurses undertake work previously carried out by doctors.

This Cochrane systematic review of randomised controlled trials investigated the impact of nurses working as substitutes for primary care doctors. 

It identified 18 trials conducted in seven countries – the UK, the Netherlands, the US, Canada, South Africa, Spain and Sweden. The studies looked at nurses in first contact care and ongoing care for chronic conditions such as diabetes. It was not always clear if the nurses were advanced clinical practitioners or registered nurses.

Equal clinical outcomes

The findings included:

  • Eight studies (rated as of low quality) suggested mortality rates were slightly lower in first contact and urgent care patients seen by nurses compared with doctors.
  • 16 studies (moderate quality) considered that clinical indicators and patient reports were equal to those seen by doctors.
  • Seven studies (moderate quality) reported higher rates of patient satisfaction from nurse rather than doctor consultations.
  • 16 studies (moderate quality) found nurse consultations were longer, with slightly higher numbers of return visits than for doctor consultations.

The effects of nurse-led care on costs could not be determined as the quality of this evidence was assessed as low. The authors conclude that for some ongoing and urgent physical complaints, nurses probably provide equal or possibly better quality of care with equal clinical outcomes to primary care doctors.


Laurant M, van der Biezen M, Wijers N et al (2018) Nurses as substitutes for doctors in primary care. Cochrane Database Systematic Review. doi: 10.1002/14651858.CD001271.pub3

Compiled by Vari Drennan, professor of healthcare and policy research at Kingston and St. George’s, University of London

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