Benefits to a General Practice of introducing a nurse-led Minor Illness service

Pressure for appointments in our practice in 1996 led us to expand the role of one practice nurse to see on-the-day cases presenting with symptoms of minor illness. This was so successful that soon we were being asked to provide training for other practices who wanted to do the same. Now, over two decades on, minor illness can be managed by a wider range of clinicians including independent prescribers, pharmacists, paramedics, physician associates as well as nurses. Our experience with four clinicians who took on this role in our practice, following the NMIC course and accreditation, is that 94% of requests for on-the-day appointments were managed without need for referral to a GP.

The benefits to our practice have been:

  • fast access into primary care for people with recent-onset symptoms
  • rewarding, autonomous professionalism for minor illness clinicians
  • more appropriate use of the doctors’ time in managing complex problems
  • more time for self-care advice leading to reduced demand for appointments
  • reduced waiting times for routine appointments (no longer competing with the 'urgent')
  • overall reduction in doctor workload
  • longer appointment times (15 minutes)
  • reduced locum fees

The disadvantages have been:

  • time invested initially in clinical supervision
  • time to attend the seminar week
  • highly skilled clinicians can command higher pay

We believe that the advantages of specialists in minor illness heavily outweigh the disadvantages. Click on the links to read reports from other practices which have introduced a similar system. These case reports are taken from an independent NHS body, the Working in Practice Partnership, and NHS England.

Case Studies

References

Brown P. (2017) A day in the life of a paramedic advanced clinical practitioner in primary care. Journal of Paramedic Practice 9(9):378-86; https://doi.org/10.12968/jpar.2017.9.9.378

Butterworth J, Sansom A, Sims L, Healey M, Kingsland E, Campbell J. (2017) Pharmacists’ perceptions of their emerging general practice roles in UK primary care: a qualitative interview study. Br J Gen Pract online first. https://doi.org/10.3399/bjgp17X691733

Caldow J, Bond C, Ryan M, Campbell NC, Miguel FS, Kiger A, Lee A. (2006) Treatment of minor illness in primary care: a national survey of patient satisfaction, attitudes and preferences regarding a wider nursing role. Health Expectations 10(1):30-45. doi: 10.1111/j.1369-7625.2006.00422.x

Drennan VM, Halter M, Joly L, Gage H, Grant RL, Gabe J, Brearley S, Carneiro W, deLusignan Simon. (2015) Physician associates and GPs in primary care: a comparison. Br J Gen Pract 65(634):e344. https://doi.org/10.3399/bjgp15X684877

Laurant M, van der Biezen M, Wijers N, Watananirun K, Kontopantelis E, van Vught AJAH. Nurses as substitutes for doctors in primary care. The Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD001271. https://doi.org/10.1002/14651858.CD001271.pub3

Mann C, Anderson C, Avery AJ, Waring J, Boyd MJ. (2018) Clinical Pharmacists in General Practice: Pilot scheme. Independent Evaluation Report: Full Report June 2018. University of Nottingham.