Nurses will run the service

Nearly 200,000 patients in Lincolnshire are no longer able to get direct access to a GP between 11pm and 8am. Instead they will speak to a nurse.

Lincolnshire South West Teaching Primary Care Trust says it has been forced into the position because of the introduction of a new GP contract.

Since April, GPs have been able to opt out of out-of-hours care.

Despite losing nearly �6,000 in NHS payments, many have done so, transferring responsibility for out-of-hours care to the local health authority.

This has meant that some PCTs have struggled to find enough GPs to staff out-of-hours services.

Nurses are highly skilled, but no-one can pretend that they are as highly skilled or as highly trained as doctors. Micheal Summers

Under the Lincolnshire scheme - which covers Stamford and Grantham - specially trained nurses, called first contact practitioners, will assess patients, and decide whether they should be admitted to hospital.

It is believed that many other health authorities are likely to adopt a similar policy.

Derek Bray, PCT chief executive, said the new scheme had the support of local GPs, and high levels of patient satisfaction.

He stressed that the nurses had been properly trained, and had support from medics, and the local A&E department.

"We are very happy with the development. We think there are many advantages in having the service being led by nurses. Many jobs that in the past were done by GPs, are now done by very experienced, specialised nurses."

Safety fears

However, the Patients' Association says patients would rather speak to a GP, and has expressed fears that lives could be put at risk.

Michael Summers, the chairman, said: "We are very worried about it. Nurses are highly skilled, but no-one can pretend that they are as highly skilled or as highly trained as doctors."

Mr Summers feared that nurses would inevitably refer more patients to hospitals - increasing pressure on already hard-ressed services.

Dr Hamish Meldrum, chairman of the British Medical Assocation's GP Committee, also urged the PCT to review its policy.

"I'm not saying that patients will be put at risk, but it may be that patients will unnecessarily have to go to hospital, partly because the people who are advising them may not have the experience to make the decision that might avoid the need for that."

Dr Meldrum said even allowing for the new contract, there should be enough GPs around to provide a service to patients out-of-hours.

New guidelines

We are talking about a very specific part of the middle of the night where a properly trained nurse, I think, is quite as adequate as a GP to make decisions. Dr Mike Dixon

In a statement, the Department of Health said: "It is for the PCT to organise suitable out-of-hours services, and this should include appropriate access to GPs.

"The Department will shortly be setting out new national standards that will clarify and put beyond doubt the importance of securing proper involvement of GPs in delivering those services."

However, those in favour of the change say it is an improvement on the old system, which placed too many burdens on over-worked and tired GPs.

Dr Mike Dixon, chairman of the NHS Alliance representing PCTs, backed the Lincolnshire scheme.

"We are talking about a very specific part of the middle of the night where a properly trained nurse, I think, is quite as adequate as a GP to make decisions.

"The decisions are really quite simple at that time of night. They are: should that patient be admitted, or can that patient be looked after at home?

"No nurse is going to look after a patient at home that is beyond their capacity, and equally they are as well trained as we are to decide who needs admitting."