Keywords: professional delegation; task delegation; general practice; primary care; nurse led clinic; nurse-led care; advanced practice nursing

Background:

Demographic shifts, the increasing prevalence of chronically ill and multimorbid patients, and the ongoing shortage of general practitioners (GPs) pose significant challenges for European general practice. Task delegation from GPs to practice nurses (PNs) through PN-led consultations may offer a viable solution.

Aim of the study:

This study examined the attitudes of GPs and PNs towards PN-led consultations in general and for specific reasons for encounter.

Methodology:

This cross-sectional survey was conducted among GPs and PNs in Saxony-Anhalt and Saxony between September 2023 and November 2024. Our self-developed, pre-tested questionnaire assessed attitudes towards PN-led consultations, reasons for encounter, potential benefits and concerns, as well as sociodemographic and practice characteristics.
We performed descriptive statistics, bivariate and multivariate analyses using SPSS version 27.

Results:

Of 2071 contacted general practitioner offices (GPOs), 437 GPs and 339 PNs participated (21.1%).
The majority of GPs (61.7%) and PNs (61.2%) were open towards PN-led consultations. In multivariate analyses, GPs showed greater openness if they had prior positive delegation experiences (OR 5.88 [95%CI 3.01;11.48]), or had already delegated specialized tasks (e.g., home visits, patient consultations, medication recommendations; (OR 5.34 [95%CI 2.29;12.46])). GPs were less open if they worked in urban GPOs (OR 0.44 [95%CI 0.22;0.88]), or owned a single GPO (OR 0.41 [95%CI 0.20;0.83]). In multivariate analyses, PNs were more willing to perform PN-led consultations if they had prior positive delegation experiences (OR 3.03 [95%CI 1.12;8.18]) and advanced practice nurse training (OR 3.50 [95%CI 1.44;8.51]).
The most commonly accepted reasons for encounter for PN-led consultations were chronic wounds, diabetes mellitus, and arterial hypertension.

Conclusions:

Roughly two third of GPs and PNs expressed willingness to implement PN-led consultations in German general practice. However, concerns regarding PN qualifications persist.
Further research should explore implementation strategies, with pilot projects focusing on structured PN training and well-defined guidelines in countries where this model remains untested.