he National Health Service (NHS) of England was established
in 1948, with general practitioners as the principal
providers of primary care and gatekeepers to other health
services. This model of care has undergone substantial change. The
GPs’ monopoly on primary care has been broken by nurse-led
services, including NHS Direct, which provides 24-hour health
advice by telephone, and NHS walk-in centres, which treat minor
illness and injury. Within general practice, GPs working alone have
given way to large multidisciplinary teams, employing six or more
doctors and a wide range of administrative and clinical staff.1
Practice nurses and nurse practitioners increasingly substitute for
GPs in the care of minor illness and routine management of chronic
diseases, such as asthma, diabetes and coronary heart disease.