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Increased nurse staffing levels improve clinical outcomes, research concludes


General practices could improve clinical outcomes if they employed more nurses per number of patients, the latest UK research suggests.

The National Nursing Research Unit at King’s College London has found that practices that employ the most registered nurses per number of patients often provide the best quality of care.

Previous research has compared performance against practice size, GP numbers and list size, but few studies have directly considered the contribution of nursing.

The research team, led by NNRU director Peter Griffiths, looked at data from 7,456 practices, contrasting nurse numbers against performance in the quality and outcomes framework – the part of the GP contract which financially rewards practices for achieving selected clinical targets.   

The research, due to be published in the next edition of the British Journal of General Practice, found practices that employed more full-time equivalent registered nurses per number of patients performed better in QOF targets for chronic obstructive pulmonary disease, coronary heart disease, diabetes and hypertension.

The authors said: “Real patient benefit may be associated with using nurses to deliver care to meet QOF targets.

“There may be scope to further shift the skill mix in primary care from doctors to qualified nurses.”


Readers' comments (10)

  • It's hardly surprising that research carried out by nurses comes down in favour of nurses. The government will be rubbing their hands as this is all about the dumbing down of healthcare and saving money rather than benefiting patients. I'm a nurse, and to be honest if there's something wrong with me I want to see a doctor in the first instance, and if, and only if, the doctor decides my ailment can be handled by a nurse, do I want to see one.

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  • I'm sure having more nurses does contribute to meeting QOF targets but the article is very misleading because meeting QOF targets is a fraction of what constitutes quality primary care and whilst nurses may be adept at managing chronic disease, complex cases and diagnoses are still better done by a medic.
    An ex practice nurse.

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  • As the author of the paper I feel obliged to respond:

    Firstly the headline 'Replace GPs with practice nurses' presents a rather misleading picture of what we concluded.

    In relation to other comments already posted it's a shame that the reader thinks that it's no surprise that 'research carried out by nurses comes down in favour of nurses' on a number of levels. It implies a necessary bias and rather ignores the fact that the majority of the research team were not in fact nurses.

    I share that reader's frustration at research that is for greater glory of nurses more than a serious attempt at determining the best approach to patient care, but I don't think that's what we have done here.

    To both these commentators and others I can only suggest that you try to read the full paper where we give a rather more considered view of what the implications are and also acknowledge that QOF activity is but a part of quality primary care.

    Those who subscribe can see the paper at

    Those who don't can at least see a full abstract.

    Peter Griffiths
    Director national Nursing Research Unit

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  • What a shame the two first responders to this article are so despondant and negative about their own profession!

    Nurses can manage patients, diagnose, investigate and prescribe just as well as doctors, if not better in some cases.

    Personally, if I was ill it wouldn't be important who the person I saw was a doctor or a specialist Nurse as long as they got the diagnosis right and managed my care well.

    Nursing's biggest barrier to its own progression, respect and development is itself! Stand up, be counted and be stronger! Research like this shows us in a good light...don't stifle that progress!

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  • I entirely agree with Adam (I hope you do not mind my use of your first name). Nurses are their own biggest enemy. Clearly, the content of the article is more enlightening than its title, but that is due to no fault of the researchers. This is the actual title of the study; 'Nurse staffing and quality of care in UK general practice: cross-sectional study using routinely collected data '. Nevertheless, the outcome of the study confirms what observant nurses have known all along. And I do not see anything misleading about the outcome of the study.

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  • How sad that the first few comments are so negative. I am a Nurse Consultant I have the greatest respect for my GP's as they do for me and we work as a team to empower patients and for staff to deliver excellent care. We are not in competition with each other and believe it or not many of our patients prefer to see me or my nursing team than the GP- that is there choice. I am able to examine ,diagnose and prescribe- I am not rying to be a GP but have 34 years of experience and work in a very extended role which my employer is more than happy to support. Without the Nursing staff in our practice our patients would not receive the high quality of care. that they do along with same day access. Nurses should stand tall and be proud of their profession - I don't want to be a doctor I am very fullfilled being a NURSE

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  • If for anything, Adam Willaims has captured my initial reaction to both the outcome of the research and the two first responders. No fault of either parties. As a nurse of twenty six years still in active service to humanty and having practiced on variety of nursing roles, I can not be too confident of immense excellent care nurses provide to their service users. Yes the skill versus risk assessment can not be over emphasised but the fact remains that given more practice nurses working in harmony with our valued GPs, the patients stands to more benefit. The time to change negative perception towards nursing as a noble profession is NOW.

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  • I do not agree with the fact that nurses should run the practices as I have experienced that they need guidance from the GP. They cannot explain all the results of investigations done on patients. They cannot diagnose and would not know the diagnosis or prescriptions to subcribe for all ailments. I am someone with chronic illnesses and would not want to be consulting a nurse when I attend the suegery or practice. The hospitals are already strained with shortages of nurses, so where will these ones come from. If you want to see nurses do more then start the training combination of nurse/doctor, two in one.

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  • I want to congratulate the Nurses who improve patient care through managing aspects of diseases using their considerable experience, skills and knowledge.

    Perhaps the time has come to recognise that chronic disease management can be safely passed on to suitably experienced and qualified Nurses; if GPs feel uncomfortable with that they could add in staff education and training from specialists. This might help to integrate the package of care GPs organise and that Nurses deliver in primary care with services provided by experts working in secondary care.

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  • Thanks to Peter Griffiths and others for your comments. It is an interesting debate.

    I would like to apologise for the original headline, which we accept was misleading and have now changed.

    Gabriel Fleming
    Online editor
    Nursing Times

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