title: The financial impact of clinical task substitution between practice nurses and GPs in New Zealand primary care centres.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Sapere Research Group, PO Box 587, Wellington 6140, New Zealand. mhefford@srghealth.com
authors.forename: Martin
authors.initials: M
authors.lastname: Hefford
authors.forename: Tom
authors.initials: T
authors.lastname: Love
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Cumming
authors.forename: Mary
authors.initials: M
authors.lastname: Finlayson
authors.forename: Antony
authors.initials: A
authors.lastname: Raymont
mesh_terms: D006301:Health Services Needs and Demand / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D009520:New Zealand; D009722:Nurse Practitioners / Q000191:economics*; D032024:Personnel Delegation / Q000458:organization & administration*; D010821:Physicians, Family / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D016526:Workload