Dr Reynolds is not the first to air concerns about finding enough nurses to staff NHS Direct 'NHS Direct will need 15,000 more nurses', (page 3, 22 October). Professor Jeremy Dale mentioned this too ('Wired for sound', 29 January). But, whether or not recruiting nurses indeed proves to be a problem, we should consider whether other health professionals may be able to give telephone advice. London Ambulance Service is testing telephone advice given by ambulance paramedics, and initial results are encouraging.

The study is funded by the national research and development programme on the interface between primary and secondary care. Working with Jeremy Dale's team at King's College Hospital department of general practice, the project pilots the use of structured telephone advice in response to 999 callers who are triaged as having neither life-threatening nor serious conditions. We are using TAS (Telephone Advice System), a computerised decision-support system developed by King's.

The first phase evaluated the use of the system by nurses in the ambulance control room. The second phase, now underway, compares both nurses and paramedics giving advice, following adaptation of the system in consultation with paramedics. Ambulances are still sent to all callers.

When completed, this research will enable policy-makers to judge the safety of advice-giving by ambulance staff as well as nurses.

Michael Honey

Chief executive

London Ambulance Service trust