Observers of general practice in the United Kingdom are quick to recognise the huge contribution practice nurses have made in recent years. In 1985, when Julian Tudor Hart described them as an underused resource, much of their work was concerned with relieving doctors of some of the simple tasks that doctors were keen to delegate.1 Since then many nurses have extended their activities into the management of chronic disease*RF 2-4* and disease prevention.5

The few comparisons between nurses' and doctors' technical excellence and acceptability to patients have mainly favoured nurses.^2,4,5 The celebrated Burlington randomised trial of nurse practitioners, using appropriateness of clinical activity as a process measure and health status as an outcome measure, showed that they performed as well as general practitioners.6 In her account of nurses extending their role in the management of diabetic patients, Murphy reported a few patients at the end of the study specifically requesting nurses to take the leading role in their care and quoted one as saying, “The doctor does have the knowledge but when it comes to the practical the nurse has the practical.”4

A recent national census of practice nurses from the University of York confirms the trend for nurses to be taking on an increasing range of tasks.7 More than 80% of nurses are involved in clinics managing chronic diseases. A similar proportion reports giving advice on minor illnesses and more than 40% identify early signs of anxiety and depression.

Several factors are responsible for this change. Firstly, there is pressure from inside …