The future of primary care lies in a sensible mixture of the skills of doctors, nurses and other health professionals

Dr Hamish Meldrum, British Medical Association

Nurse practitioners, who are defined in the research as nurses who provide the first point of contact for patients, make an initial assessment and manage patients autonomously, are becoming more and more common in the NHS.

Walk-in centres, the telephone advice line NHS Direct and some primary care centres are now nurse-led.

In a paper published in the British Medical Journal, researchers from the Department of Primary Care at the University of Bristol, led by Dr Chris Salisbury, wrote: "Nurse practitioners can provide care that leads to increased patient satisfaction and similar health outcomes when compared to care from a doctor.

"Nurse practitioners seemed to provide a quality of care that is at least as good, and in some ways better, than doctors."

Nurses in 'front-line'

The researchers said more work needed to be carried out to examine if differences in the training and consultation skills of nurses affected patient's perceptions.

Doctors may also be affected by other demands on their time, such as home visits, in addition to having to deal with a wider range of problems and diseases, which nurses do not have to deal with.

Dr Salisbury and his colleagues add that most research that has been carried out into nurse practitioners' work looked at patients wanting same day appointments for minor illnesses - a small part of doctors' workload.

Dr Salisbury told BBC News Online: "Different ways of operating the service need to be looked at. You could have nurses providing the first line of care."

Lynn Young, Royal College of Nursing primary care adviser, said patients should have the option of seeing the GP or the nurse practitioner, dependent on what care they needed.

"GPs should be accessible to those patients who need them, rather than trying to see everyone in a very short space of time.

"That is unsatisfactory to both patients and GPs.

"Nurse practitioners have a very important part to play in terms of health care provision."

'Sensible mixture'

Dr Hamish Meldrum, joint deputy chairman of the BMA's GPs Committee, said: "The BMJ paper recognises that the nurses were working predominantly with minor illness in a team supported by doctors.

"They did not necessarily work under the same pressures as their GP colleagues and, as the paper states, it cannot be assumed the same results would be obtained in different settings, with different groups of patients, nor that they could substitute entirely for GPs."

He added: "We are anxious to relieve pressure on all health professional's time so they can give patients the quality service they deserve.

"The future of primary care lies in a sensible mixture of the skills of doctors, nurses and other health professionals."

However, Claire Rayner, of the Patient's Association, said the survey underlined that nurses had a better rapport with patients.

She said: "Nurses are trained from the very beginning to be much more tolerant and whole-person centred than doctors ever are.

"Some of this is to do with nurses' ability to make a person feel that at that moment in time he or she is the most important person in the world, and on the whole doctors are not terribly good at doing that."