Opinion  

Much has been achieved in general practice since then. Nurse practitioners are well established, nurse prescribing is a success and nurse partners are increasingly common.

However, some practices and GPs have been resistant to change. So it is encouraging to see that two of the architects of the new GMS contract, Drs Simon Fradd and John Chisholm, are embracing the idea that nurses could provide almost all first-contact care.

Their company, Concordia Healthcare, is rolling out such a model in south-east London and it offers an exciting vision of how general practice could evolve.

The DoH will, no doubt, be interested in this new way of working - not least because it delivers 50 per cent more appointments for the same cost. And, as Dr Fradd points out, it could also free up GPs to concentrate on issues like practice-based commissioning. But there are factors that must be considered if this model is to be used on a wider scale.

Firstly, nurse practitioner numbers will need to increase dramatically. Independent Nurse recently reported that the NHS will face a shortfall in nurse practitioners within 10 years unless more are trained (IN, 4 February). Many trusts and SHAs have small or non-existent training budgets so greater funding in this area would be essential to achieve any significant change in doctor:nurse ratios.

Secondly, the NMC's advanced nurse practitioner register must be in place to ensure only nurses with the right training take on advanced roles. Regulating the role would also make clear the training and experience these nurses have and address any concerns about patient safety.

It is unlikely Concordia's ideas will take off across primary care quickly - or that they will find a receptive audience with all GPs. But they do show signs that, eventually, nurses could lead the way in primary care.

emma.bower@haymarket.com