The financial impact of clinical task substitution between practice nurses and GPs in New Zealand primary care centres

N Z Med J. 2011 Sep 9;124(1342):59-65.


Aim: To describe the financial impact on practice owners of increased clinical task substitution between practice nurses and GPs in New Zealand (NZ) primary care settings.

Method: Case studies of 9 primary health care centres involving: interviews; collation of service and financial information; and nurse and GP diaries covering 1826 consultations. Results were compared with previous NZ large N survey results to develop a model predicting the financial impact of task substitution.

Results: The proportion of general practice primary care consultations undertaken by nurses varied from 4% to 46% of total recorded consultations. The actual financial impact for a practice owner of substituting more nursing time for GP time is highly dependent on the following variables: nurse cost per minute relative to GP cost minute; nurse consult duration relative to GP consult duration; nurse consult revenue relative to GP consult revenue; and the proportion of nurse consults also requiring GP time.

Conclusion: Practice nurses can (and in some practices in NZ, do) provide a broad set of primary care services, including undifferentiated general consultations. For some practices, increasing the proportion of nurse consults and reducing GP consults, would result in significantly improved profitability--for others, the opposite applies. Clinical task substitution is one option to address the forecast increase in demand associated with population aging.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Health Services Needs and Demand / economics*
  • Humans
  • Interviews as Topic
  • New Zealand
  • Nurse Practitioners / economics*
  • Personnel Delegation / organization & administration*
  • Physicians, Family / economics*
  • Primary Health Care / economics*
  • Workload