Nurses and doctors in primary care: decisions should be based on maximizing the cost effectiveness of a system of primary care and not the dictates of historical precedent

The past 10 years have seen an increase in the number of nurses working in general practice, which has been largely unplanned. On a background of limi ted resources and a commitment to a primary care-led National Health Servic e (NHS) based on team work, delivering care from a mixed team of general pr actitioners (GPs) and practice nurses offers an attractive model for policy makers. To date, this development has been characterized by roles reflecti ng historical precedent and conflicts of power. This paper argues for a bre ak from traditional professional roles and the devolution of power across t he primary health care team. Although the problems of economic analyses are recognized, the development of skill-mix should be based on considerations of cost effectiveness and not historical sentiment.