By Ray Dunne BBC News Online health staff

Nurses are playing a much bigger role

David Russell has been a GP for almost 20 years. For most of his career, he has had to be available 24 hours a day for patients.

"It was quite stressful," he says. "You sometimes worried if you were called out in the middle of the night and then had to do a full day's work the next day."

That all changed on 1 April. The introduction of the new NHS contract for GPs meant Dr Russell could, for the first time, opt-out of providing out-of-hours care.

"It has been a breath of fresh air," says the Darlington GP. "It means I no longer have to do evenings and weekends. It has made a massive difference."

Under the terms of the new contract, responsibility for providing out-of-hours medical care passes from GPs to NHS primary care organisations.

The change is being phased in over the course of this year, although some parts of the country are moving faster than others.

Some hiccups

By and large, everything appears to be going reasonably well, although there have been one or two hiccups.

Health chiefs in Norfolk revealed this week that they are relying on doctors from Germany flying in to provide emergency cover at weekends because local GPs don't want to do the work.

I no longer have to do evenings and weekends Dr David Russell

This is despite the promise of �80 per hour and the chance to earn up to �2,400 over the course of the weekend.

The fact is few British GPs now want to work out-of-hours. A survey of 3,000 doctors, published in December, suggested as many as 80% intend to opt-out.

Figures like these have forced health chiefs across the country to come up with a new way of delivering care to patients when local GP surgeries close.

The government has given the NHS in England �100m to come up with a workable alternative.

Health chiefs in Darlington have signed up a private company called Primecare to run its out-of-hours service.

Faced with a shortage of GPs, the company has decided to employ a new breed of health worker called emergency care practitioners.

"Most ECPs are either paramedics or nurses by background," says Dr Mike Sadler, Primecare's medical director.

"But they receive additional training to qualify them to deal with the urgent care needs of individuals."

These ECPs could become the backbone of NHS out-of-hours in the years ahead.

"I think nurses and paramedics can become integral to the out-of-hours team, just as nurses have become integral to the in-hours team," says Dr Mark Reynolds, chairman of the National Association of GP Co-operatives.

"No self-respecting practice goes without a nurse during the day. The same will happen for out-of-hours."

Wide support

The new arrangements certainly appear to have the support of paramedics and nurses.

"We think it's a very good thing," says Roland Furber, chief executive of the British Paramedic Association.

Patients will have much faster access to medical help and advice Spokeswoman, Royal College of Nursing

"Doctors are not going to be available out-of-hours like they have been. It seems logical to use paramedics and nurses."

The Royal College of Nursing agrees and says the changes will benefit patients.

"Patients will have much faster access to medical help and advice," says a spokeswoman.

"They won't have to wait to see a GP. They will be able to see a nurse instead."

But do patients want to see a nurse or paramedic instead of GP?

"It was something that concerned us," says Dr Russell, who now sits on a committee overseeing the out-of-hours changes in Darlington.

"But we have had really positive feedback from patients. It has certainly exceeded my expectations."

Perhaps patients are starting to get used to the fact that they won't always see a GP.

Nurses are now the first port of call for patients in many parts of the NHS. They are running walk-in centres and specialist clinics and are the voices behind the telephone helpline NHS Direct.

"They conduct millions of consultations each year," says Mark Reynolds. "Patients like them."

There is evidence to suggest that in some cases nurses and other healthcare workers may actually be better than doctors.

"We know that nurses and other health professionals do rather better than doctors when it comes to certain things," says Dr Sadler.

"They are better at reviewing medication or offering healthcare advice. They are also more cost-effective."

But the changes do not mean that GPs will now disappear in the evenings and weekends.

While there will be fewer of them around, they will be on hand should patients need them.

"This is not about not having doctors anymore," says Dr Sadler.

"It's about using doctors for what they do best and using other health professionals for what they do best.

"It's about not relying on a single doctor 24 hours a day. I think patients will value that."