Nurse Led Clinics – 5 Finance Factors

Nurse led Clinic

Nurse led clinics have the potential to be a ‘win – win’ for everyone involved. Patients get more targeted care, nurses get more job satisfaction and hospital trusts get more value for money.


Like many things in life though, the devil is in the detail.

Some nurse led clinics have a transformative effect, but others can end up costing a lot of money.

So in this week’s blog I’m looking at the five finance factors to consider when NHS accountants get involved in setting up a nurse led clinic.

What, then, constitutes a nurse led clinic?

Generally it’s where nurses assume their own patient caseloads, provide health education to patients, provide psychological support, monitor patient conditions and perform nursing interventions.

What actually goes on in these clinics can vary widely, but the key commonalities are ‘autonomy’ and a defined caseload of patients.

In the UK, advanced nursing practice has developed since the 1980s in response to two main factors:

Firstly there has been an increase in health needs and cost, influenced by both demographics and advances in health policy.

Secondly the “new deal for junior doctors”, which was a government response to the European Community directive to reduced junior doctors’ hours of work, put more focus onto nursing care.

Some clinical areas naturally lend themselves to nurse-led care, particularly chronic chronic conditions such as diabetes, COPD and musculoskeletal disorders. In fact treatment guidelines in rheumatoid arthritis actually specify the role of nurses in managing the disease.

NHS finance professionals have a big part to play in setting these clinics up and then managing their performance.

Over the last twelve years, working in hospital trusts across the UK, we’ve identified 5 key financial factors that need to be considered before plunging in:

  1. Clinical need must be established. Why is the clinic being set up? Financial and other benefits can best be articulated in a business case. The more preparation at this stage, the less heartache later.

This business case should include identifying the typical cohort of patients that the clinic will treat.

  1. Next a suitable location needs to be found. What facilities will be required? Will it be convenient for patients? Are there any issues over the rent or lease if the clinic is operating away from a hospital site?
  1. Then a decision needs to be made on how the performance of the clinic will be measured. What metrics will be tracked, both financial and non financial? This should include an awareness that performance will increase over time as the clinic beds in.
  1. Perhaps crucially from a finance perspective, will the cost of patient activity be covered by the income available under PBR?
  1. Finally, as with any new service, there needs to be a communication plan so that referring professionals know the clinic exists. This includes both other teams around the hospital and external stakeholders such as GPs and other health professionals.

That’s our list.

I’d be really interested to hear if anyone reading had their own experiences of setting up these clinics, so do drop me a line if you’ve got an opinion on it.

Thanks for reading.