Table 1

Overview of services.

ServiceAims of initiativeStrategiesTarget population
Personal medical services• To make primary care more locally responsive• Allowing participating GPs the option of being salariedPreviously under-served groups
• To address problems of GP recruitment and retention• Allowing nurses and former community trusts to take a lead on providing primary care for the first time
• To enable closer working relationships within the PCT• Allowing GPs the option of providing extended services
• To introduce greater flexibility in general practice• Providing primary care services in areas where care has been previously unavailable
• To address inequalities in the provision of health care• Targeting services to the needs of local vulnerable and marginalised groups
Telephone consultations with GPs or nurses• To reduce unnecessary face-to-face consultations• GPs and nurses utilise telephone consultations to triage patients, and provide telephone advice and authorise repeat prescriptions where appropriatePatients requesting same-day appointments
Nurse practitioner-led care• To increase access to primary care in under-served areas• Nurses roles are developed through increased training opportunities so that they may work independently, diagnosing, prescribing, treating and referring patients onwards where appropriatePatients consulting for minor conditions in busy general practice sites
• To reduce GP workload for minor conditions
Walk-in centres• To provide more easily accessible primary care that is centred around the needs of the local population• Nurse-led primary care centres established in convenient areas with extended opening hours and walk-in access, providing health care/advice for minor conditions and health promotionLocal communities
• Nurses are supported by computerised clinical decision software and frequently a GP is available on-site
NHS Direct• To provide more easily accessible primary care• A 24-hour nurse-led telephone service offering healthcare advice and acting as a triage point for referrals to other servicesAll of England and Wales
• To reduce unnecessary demand on other primary care services• NHS Direct effectively utilises skill mix employing nurses, trained call handlers and GPs
• Nurses are supported by computerised clinical decision-making software
• NHS Direct is available online
Pharmacist-led initiatives• To provide more easily accessible primary care for minor conditions• The role of the community pharmacist is enhanced to include medicine management; pharmacists are able to dispense certain medications without a prescription from a GP (pharmacists are guided by a prescription formulary)Patients with self-limiting/minor conditions
• To reduce unnecessary demand on other primary care services• NHS Direct is able to refer directly in some instances to community pharmacists
• Training programmes and skills checks have been established for pharmacists