bmj.com -- Press Releases

Releases Saturday 15 April 2000
No 7241 Volume 320

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(1) CARE OF MENTALLY ILL PRISONERS WELL
BELOW NHS STANDARDS

(2) NURSES COULD COST THE NHS LESS THAN GPs
FOR THE SAME RESULTS

(3) COSTS OF NURSE TELEPHONE CONSULTATIONS
OUT OF HOURS OUTWEIGHED BY SAVINGS

(4) PATIENTS AS HAPPY TO BE SEEN BY NURSES AS
BY GPs FOR SAME DAY CONSULTATIONS

This week's BMJ contains a selection of articles on the use
of nurses in general practice covering cost effectiveness,
acceptability to patients, as well as a postal survey of the
usefulness of NHS Direct. There are also articles on nursing
numbers and how the shortfalls might be addressed and a
debate about whether doctors and nurses should monitor
each others' performance. Some of this research is also
summarised in this week's issue of the Nursing Times,
contact details for which are given at the end of the release.

(1) CARE OF MENTALLY ILL PRISONERS WELL
BELOW NHS STANDARDS

(Inpatient care of mentally ill people in prison: results of a
year's programme of semistructured inspections)
http://bmj.com/cgi/content/full/320/7241/1031

The care of mentally ill prisoners in prison healthcare centres
falls well below that provided for mentally ill patients in the
NHS, finds research in this week's BMJ. Most prison
inpatients are mentally ill and the Prison Service has aimed to
provide the same standard of health care as the NHS since
1991.

Reed and Lyne from HM Inspectorate of Prisons, conducted
a semi-structured survey of 13 prisons with inpatient units in
England and Wales as part of the routine prisons inspection
programme during 1997-98. The 13 prisons had 348 beds,
20 per cent of all inpatient prison bed capacity.

The survey revealed that facilities were often poor, staff
numbers were low, and many staff were not sufficiently
trained. Only one in five of the nursing staff had received
mental health training, and almost a third had not had nurse
training. None of the doctors in charge of inpatients had
completed specialist psychiatric training. Most prisons kept
patients unlocked for around 3.5 hours a day rather than the
12 hours required by current prison service standards.
Therapeutic activity was limited, and periods of exclusion
were lengthy, averaging 50 hours.

The authors conclude that prison should provide an ideal
opportunity to diagnose and treat mental disorders among
people who don't often use NHS services, and to ensure
they receive appropriate treatment. And this not only benefits
those who are ill but also the community at large when they
are released. But they found little evidence that this was being
effectively carried out. They call for more NHS involvement
in treating mentally ill prisoners.

Contact:

Dr John Reed through Jean Ward at the Home Office,
London.

(2) NURSES COULD COST THE NHS LESS THAN GPs
FOR THE SAME RESULTS

(Randomised controlled trial comparing cost effectiveness of
general practitioners and nurse practitioners in primary care)
http://bmj.com/cgi/content/full/320/7241/1048

Nurses could cost the NHS less than general practitioners in
certain circumstances, suggests a study from the University of
Manchester in this week's BMJ.

Venning and colleagues compared the health outcomes and
costs of nurse and General Practitioner consultations across
20 general practices in England and Wales. Overall, just
under 1300 patients attending for same day consultations
were randomly assigned to a GP or a nurse practitioner.

The results showed that consultations with nurses were
almost twice as long as those with GPs. Nurses were also
two thirds more likely to order more tests, carry out more
opportunistic screening, and significantly more likely to ask
patients to make a repeat appointment. But there were no
significant difference in prescribing patterns or health
outcomes for the patients treated. And patients were also
more satisfied with nurse consultations, a fact which remained
even after adjusting for length of time spent with the patient.
And there was scarcely any difference in cost between
doctors and nurses, although costs to the NHS were 12.5
per cent lower for nurses. The authors suggest that if nurses
were able to shorten their consultation times or reduce the
return appointment rate, they could even be cheaper than
general practitioners.

Contact:

Dr Pamela Venning, Nurse practitioner and honorary
lecturer, University of Manchester School of Primary Care.
Email: pamelavenning{at}gofree.co.uk

(3) COSTS OF NURSE TELEPHONE CONSULTATIONS
OUT OF HOURS OUTWEIGHED BY SAVINGS

(Cost analysis of nurse telephone consultation in out of hours
primary care: evidence from a randomised controlled trial)
http://bmj.com/cgi/content/full/320/7241/1053

The costs of telephone lines operated by nurses for out of
hours primary care may save the NHS money in the long
term, indicates research from the University of Southampton
in this week's BMJ.

Lattimer and colleagues conducted a cost analysis of out of
hours nurse telephone consultations for a general practice
cooperative in Wiltshire, England for 12 months from January
1997. The cooperative includes 55 general practices serving
97,000 registered patients.

The costs of providing the telephone consultations amounted
to just over £81,000 for the year, but over £94,000 was
saved from reducing the demand for emergency admissions
to hospital for both adults and children. If this figure were
achieved across England, say the authors, it would be
comparable with the estimated costs of providing NHS
Direct sites at a cost of £1 per head of the population per
year. Additional savings of almost £17,000 were made as a
result of a reduced need for GPs to visit patients in their
homes and fewer surgery appointments within three days of
making a call. But, say the authors, GPs currently bear most
of the cost of nurse telephone consultations and stand to gain
least from the savings associated with it. The authors warn
that the results may not apply where there is more than one
access point to out of hours primary care services.

Contact:

Dr Val Lattimer, Health Care Research Unit, University of
Southampton.
Email: val{at}soton.ac.uk

(4) PATIENTS AS HAPPY TO BE SEEN BY NURSES AS
BY GPs FOR SAME DAY CONSULTATIONS

(Nurse management of patients with minor illnesses in general
practice: multicentre randomised controlled trial)
http://bmj.com/cgi/content/full/320/7241/1038

(Randomised controlled trial of nurse practitioner versus
general practitioner care for patients requesting "same day"
consultations in primary care)
http://bmj.com/cgi/content/full/320/7241/1043

Two studies in this week's BMJ show that patients
requesting same day consultations are as happy to be seen by
a nurse as their general practitioner, and in some cases, prefer
the experience.

In a trial of five general practices across South East London
and Kent, Shum and colleagues show that patients were
significantly more satisfied with consultations given by
practice nurses than those given by GPs. Patients scored
nurse consultations an average of two to six points higher.
Around 1800 patients with minor illnesses who requested,
and were offered, same day appointments took part in the
study.

The nurse consultations lasted around two minutes longer;
length of time spent with a patient has traditionally predicted
greater satisfaction scores. But, say the authors, patients still
rated their nurse consultations more highly even after
adjusting for this. Nurses and doctors wrote prescriptions for
a similar proportion of patients and there was no difference in
clinical outcome between the two groups of patients. Around
three-quarters of patients were treated without any input from
the GP.

Another trial conducted by Kinnersley and colleagues from
the Department of General Practice, University College of
Wales College of Medicine, compared the outcomes of
consultations given by GPs and nurse practitioners in 10
general practices in South Wales and South West England.
Over 1300 patients requesting same day appointments were
involved.

Generally, patients consulting nurse practitioners were
significantly more satisfied with their care, having been given
longer consultations and more information about their
illnesses. There was no difference in the rate at which
symptoms cleared up, the resolution of concerns, or the
amount of drugs prescribed between doctors and nurses.
Although satisfaction scores were significantly higher for
children seeing nurse practitioners, there was some variation
among the adults, which, the authors suggest, indicates the
impact of individual doctors.