Are nurse-led patient consultations acceptable for the general practitioners and practice nurses in Germany? Results from a cross-sectional survey in two federal states

Abstract

Objective Demographic changes, increasing prevalence of chronically ill and multimorbid patients and the ongoing shortage of general practitioners (GPs) collectively present significant challenges for European general practice. Task delegation from GP to practice nurse (PN)-led patient consultations could be a potential solution to tackle those challenges. Therefore, this study aimed to examine the attitudes of GPs and PNs towards PN-led consultations in general and for specific conditions. Design Cross-sectional survey using a self-developed, pretested questionnaire, conducted between September 2023 and November 2024. The questionnaire assessed attitudes towards PN-led consultations, conditions within PN-led consultations, possible benefits and concerns regarding PN-led consultations, sociodemographic characteristics and characteristics on GP offices (GPOs). We performed descriptive statistics, univariable and multivariable regression analyses using SPSS V.27. Setting GPOs located in the German federal states of Saxony-Anhalt and Saxony. Participant From 2071 contacted GPOs, 437 GPs and 339 PNs participated (GP response rate: 21.1%). Results The majority of GPs (61.7%) and PNs (61.2%) were open towards PN-led consultations. In multivariable analysis, GPs showed greater openness if they had prior positive delegation experiences (OR=5.88, 95% CI (3.01 to 11.48)) or already delegated special tasks (OR= 5.34, 95% CI (2.29 to 12.46)). GPs were less open if they worked in urban GPOs (OR=0.44, 95% CI (0.22 to 0.88)) or owned a single GPO (OR=0.41, 95%CI (0.20 to 0.83)). In multivariable analysis, PNs were more open towards PN-led consultations if they had prior positive delegation experiences (OR=3.03, 95% CI (1.12 to 8.18)) and advanced PN training (OR=3.50, 95% CI (1.44; 8.51)). The three most accepted conditions by GPs and PNs for PN-led consultations were chronic wounds, diabetes mellitus and arterial hypertension. Conclusion Our findings demonstrate broad openness among both GPs and PNs towards PN-led consultations in German GPOs in general, and for various acute and chronic conditions. PN-led consultations are already partially practised. The results indicate considerable potential for further delegation beyond current national agreements. Future pilot studies should further develop PN roles and provide evidence of feasibility and non-inferiority of PN-led consultations compared to GP-led consultations. Conditions and participant characteristics investigated may serve as a foundation for study design and participant recruitment.