The multicentre randomised controlled trial by Williams and colleagues (doi:10.1136/bmj.b231) compares the clinical effectiveness of doctors and nurses undertaking upper and lower gastrointestinal endoscopy. The study by Richardson and colleagues (doi:10.1136/bmj.b270) assesses the cost effectiveness of this approach. The studies found no significant difference in clinical outcomes, although doctors seemed to be more cost effective.1 2

Nurse led services in the United Kingdom have been encouraged by government policy, a shortage of doctors, a willingness of nurses to adopt expanded roles, and a salaried NHS workforce where professionals are not in competition for income from patients. Evaluations of substituting doctors with nurses have consistently found little difference in performance. In primary care, no appreciable differences between doctors and nurses have been found in health outcomes for patients, process of care, or use and cost of resources, whereas nurse led care has resulted in higher patient satisfaction.3 These findings have been reported across a wide range of diseases. Nurse endoscopists are firmly established in the UK, with 350 nurses currently in practice.

Endoscopy is a diagnostic test so the results might …