Nurse practitioners.

The establishment of nurse practitioner clinics will get a mixed reception. Some will see it as a dumbing down of the health system - while others will see it as a logical extension to meet a doctor shortage.

Both may be partly right. It will all depend on whether the relationship between doctors and nurse practitioners develops on an amiable basis - or degenerates into a poisonous battle of personalities.

It is presently a fact of life that we have to take up a doctor's valuable time when all we want is a script renewed or a new referral to a specialist. These can be serviced by a trained nurse just as easily.

The danger may come if we continue to consult that nurse instead of a doctor and we develop a disease that is beyond that nurse's capacity to recognise. The success - or failure - of the scheme will depend of the right mix of doctor/nurse attendance to cover the whole medical spectrum.

And that brings us right back to the doctor/nurse relationship ! In an ideal world the nurse would steer the patient to see the doctor at reasonable intervals and the doctor would steer the patient to the nurse for routine script/referral matters.

This will eventuate in some practices, but unfortunately in many others it will develop into a turf fight. Some doctors will dig in their heels and forbid their patients to go elsewhere, despite a patient overload - and some nurses are going to jump on the feminist bandwagon and declare doctors an unnecessary band of parasites !

In the end, it will all come down to patient intelligence. The right choice is in the hands of the patient to regulate his or her visits between the two.