The new deadline of December 2000 for extending NHS Direct, the government's nurse-led telephone helpline throughout England is 'challenging but feasible' according to one of the scheme's advisers.

But Kent GP Dr Mark Reynolds, one of the driving forces behind GP co- operatives which already use nurse-lines, warned that it would need an extra 15,000 nurses despite the current recruitment and retention crisis.

The new deadline was set last week by health minister Alan Milburn when he spoke to a GP co-operatives conference at Warwick University.

Dr Reynolds, who is a member of the national advisory group on NHS Direct, told HSJ that most GPs are concentrating on setting up primary care groups. One of the biggest problems in rolling out NHS Direct would be recruiting 15,000 experienced nurses to run it.

'This sort of job may well attract those who have left nursing to have a family but want to return on a part-time basis, doing around 10 to 15 hours per week,' Dr Reynolds said.

It might be that district nurses, practice nurses, and those working in trusts, could be cycled through the NHS Direct system as a way of improving and enhancing their clinical skills.

Dr Reynolds said: 'There is no doubt in my mind that once patients become familiar with it they will like the service.'

Trials of nurse-run schemes in Wiltshire, which pre-dated the NHS Direct pilots set up by the government, have resulted in a 40 per cent drop in patients' visits to surgeries and a cut in hospital admissions and casualty visits.

Dr Steven George, who studied the trials, said: 'The main concern people have had with nurse telephone consultation is the risk of 'missed cases'. Our study demonstrates this concern is unfounded.'

The first wave of NHS Direct sites, in Newcastle, Milton Keynes and Preston, went live in April. The second wave, selected by tender, will be launched next April and will extend coverage to 20 million people - 40 per cent of the population.

The third wave will be identified by NHS Executive regional offices which will decide how the service will be run, and how GPs, ambulance trusts, A&E departments, social services and other relevant groups are to liaise.

'We must aim for a time when a patient's call to NHS Direct is as common as picking up a prescription. We recognise that this will take time to achieve but there are a number of steps we are taking to make it happen,' Mr Milburn said.

He acknowledged fears about the pace of change.

'There have been some commentators who have criticised the speed of implementation. I make no apologies for it. As I have already made clear, this is a service whose time has come.

'It matches the growth of other 'direct' services and the public expectation for more convenient, round-the-clock access to help with health problems.'

The Royal College of Nursing, which estimates that there are 8,000 NHS vacancies for qualified nurses and 8,000 unfilled student places, welcomed the extension of Nurse Direct.

'Alan Milburn's latest proposal for developing NHS Direct is a powerful vote of confidence in a nurse-led service,' the RCN said.