Sources close to prime minister Tony Blair have told senior nurses he is 'hopping mad' with the 'shambles' of nursing in primary care, where there are eight different types of practitioner.

Ministers look set to launch a review of the situation, looking at removing some of the distinctions between health visitors, district nurses, school nurses and other practitioners.

A Department of Health nursing spokesperson said an external reference group was being set up to look at 'integrated nursing teams', in which practitioners would work closely together.

The Royal College of Nursing welcomed the move. Community health adviser Lynn Young said: 'There are questions about the community nurse workforce. Do we need eight different disciplines when the whole focus of the NHS is on primary care?'

She said her personal view would be to back 'advanced primary care nurses' who could 'provide broader, more family-centred care' than the existing disciplines.

But Unison head of nursing Karen Jennings said: 'We have been very strong in our view that we need to retain the distinction between different specialties.'

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