The rapid implementation of NHS Direct has alienated many GPs and may hinder its future development, according to a study of London s first two schemes.

GPs resented the government s insistence on rolling out NHS Direct across the country before the pilot study evaluations were available, according to the Kings Fund study .

They also expressed concern about the impact of NHS Direct on existing services and on the role of the GP as gatekeeper .

NHS Direct: learning from the London experience says the future success of the scheme hinges on overcoming GP ambivalence and developing effective working relationships between primary care stakeholders.

Local GPs were affected by the scepticism and hostile publicity created at a national level by the scant consultation with clinicians over the development of NHS Direct; its expansion before evaluation results were available and the perception that NHS Direct is being used by politicians to divide nurses and doctors.

The schemes in west and south London were both found to be well established, with rising call numbers.

But the impact of the telephone service on the quality of health services remained unclear . The report calls for national standards to ensure uniform quality across all NHS Direct sites, in areas including staff recruitment and training, information technology provision and support, and protocol quality.

Several interviewees described organisational problems arising from the scheme s messy management structures, in particular the management of nurses through local trusts while call-handlers were managed by an NHS Direct general manager .

NHS Direct: learning from the London experience. Kings Fund bookshop.0171-307 2591.£5.99.