The Meadowfields Practice in Derby has been working along such principles for 10 years (GPs to make nurse-led care a reality ). Nurses not only deliver significant first point of contact care and all chronic disease management, they also employ the medical staff, liberating them from all administrative concerns.

The Meadowfields model has demonstrated that nurses frequently manage 75-80 per cent of all contacts with the surgery, triaging calls, dealing with problems over the phone and seeing patients with undifferentiated need, as well as undertaking traditional roles such as long-term conditions management. PBC also offers the Meadowfields Practice a great deal of scope for developing a nurse-led role in other areas too.

The model was intended to promote the role of the nurse within general practice. I felt it was more appropriate for the nurse to deal with many patient problems and that having such skilled clinicians in the workforce was better for patient care.

Meadowfields has more than 7,500 patients over two sites so we need 2.6 full-time-equivalent doctors. We have a very high QOF rating and patient satisfaction rates. I can assure Dr Fradd and the government that the model works well.

Perhaps if the government had spent more time looking at the PMS pilots rather than negotiating the new GMS contract, it would have been aware of what we were achieving. It could then have invested more in developing the nurse entrepreneurs who are single-handedly swimming against the NHS and 'GP-land' tide.

The nursing workforce has a tremendous amount to offer primary care and my model has shown a cost-effective, efficient, acceptable and safe alternative to the traditional model.

Catherine Baraniak, OBE, nurse principal, Meadowfields Practice, Derbyshire.

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