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

M Hefford, T Love, Jacqueline Cumming, Mary Finlayson, Antony Raymont

Research output: Contribution to journalArticle


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.
Original languageEnglish
Pages (from-to)59-65
Number of pages7
JournalNew Zealand Medical Journal
Issue number1342
Publication statusPublished - 2011
Externally publishedYes


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