'At the moment I can't even sign a prescription'

Case study: The nurse

Catherine Baraniak is one of only two nurses who run general practices in Britain. She employs a GP and other staff and is working to change the NHS culture, in which patients expect to see the doctor as a first, not a last, resort.

Catherine Baraniak is one of only two nurses who run general practices in Britain. She employs a GP and other staff and is working to change the NHS culture, in which patients expect to see the doctor as a first, not a last, resort.

"We give patients a choice of who they see. We find 60 per cent elect to see the nurse and are quite happy with the care they receive," she said.

She is constrained, however, by the restrictions on nurses. "I need to be able to prescribe the contraceptive pill, asthma medication and other drugs, but at the moment I can't sign a prescription. I think it is unfair to ask the GP to sign for a patient whom he has not seen."

Under the NHS plan, nurses will be able to do extra clinical work, such as prescribing drugs, making referrals and ordering investigations, to allow more flexible working.

Most patients at the surgery in Derby have non-medical problems - marital or family difficulties - and do not need to see the GP, Dr JoeZammit-Maempel. "By taking the workload off the GP he is freed to concentrate his skills on those who need him," she said.

Under yesterday's national plan, nurses will be able to do more of the work done by doctors, expanding the capacity of the NHS. Ms Baraniak, 42, said her practice had grown from 500 to 2,100 patients in two years. Under the plan, "we would be able to have practices with larger list sizes run with one doctor", she said. "Patients really like it [the nurse-run practice]. I think it is the model for the future."