New policies, new contracts, and financial pressures have altered the roles of primary care nurses and health visitors and their relationship with general practitioners (GPs). How will the primary care trust survive?

In remote areas of some rich nations (such as rural Australia) highly trained nurses provide the core of primary medical care for adults and children. In many developing nations (such as Bangladesh and China) locally trained nurses tend to work in hospitals and private clinics in towns, whereas health care in rural communities often depends on lay medical aides and occasionally doctors. In the United States nurses manage care for chronic disease.1

In the United Kingdom, some nurses are employed by independent contractor GPs, while others including health visitors are attached to general practice teams but are paid and managed by primary care organisations. They …