Costing practice nurses: implications for primary health care

General medical practice has changed significantly in the past ten years, reflecting a range of innovations giving greater priority to health prevention and promotion and to primary health care generally. One consequence has been a rapid increase in the number of practice nurses. Since 1988 the number of whole-time equivalents has trebled and most practices now employ at least one nurse. Practice nurses make an increasingly important contribution to both the practice team and the delivery of primary health care. They undertake a wide range of activities, in the practice and the patient’s home, including traditional nursing tasks, chronic disease management, health promotion, new patient registration health checks, counselling, advice, investigation, treatment and health assessments of elderly people. There is, however, widespread uncertainty about their role and how it might develop. Cost has been largely ignored because where the money comes from, that is who bears the cost of practice nurses, is to a great extent divorced from the responsibility for their employment. General medical practitioners who employ nurses are usually reimbursed by Family Health Service Authorities for most of the nurse’s salary. This paper provides unit cost estimates of practice nurses and discusses the implications for their future role and deployment. As well as direct costs, it considers the wider opportunity cost associated with the growth in practice nurse numbers.