“Dr Nurse,” “Noctor”—just two of many slights used to describe senior nurses who take on some medical roles or, worse still, take a job previously carried out by a doctor.

But how far is this paranoia? In secondary care, nurses are doing endoscopy, minor surgery, and anaesthesia. The United Kingdom has between 3000 and 5000 advanced nurse practitioners, including those working at junior doctor level or higher. The number of registered nurse prescribers has grown 27% between 2004 and 2007 to over 45 000 nurses.1

Former prime minister Tony Blair made a direct challenge to doctors by extending prescribing to nurses and pharmacists in the late 1990s. Health minister Ara Darzi, in his report on the NHS workforce in July, emphasised the need for increased investment in continuing professional development to allow existing staff to expand their roles. Health secretary Alan Johnson is said to be interested in using health centres run by companies such as Tesco and Virgin to swell the number of nurse-led practices.