Letters about telephone advice (19 February) serve to illustrate the positive and negative aspects of current approaches to health service provision.

The current use of nurses in out-of-hours general medical services is the direct result of GPs' dissatisfaction with perceived patient misuse of the service and their increasingly apparent inability to deal appropriately with it within their current funding and numbers, despite money being made available to help.

Nurses' involvement in 888 pilots is the direct result of accident and emergency and ambulance service dissatisfaction with perceived inappropriate use of emergency services.

Increasing numbers of nurses have been improving, formalising, integrating and auditing documented telephone advice to patients. The work of these organisations is the basis of current patient satisfaction with telephone advice. But this is aimed at a clearly defined client base: the traditional local community primary care need. How and why is that different from hospital and community health service advice?

The local population doesn't care who is paid to keep them advised. It wants access to integrated, collaborative, efficient telephone services which know about local resources, referral arrangements, idiosyncrasies. A telephone service strategically requires collaboration and unified effort, information and knowledge. It does not need several different advice centres, all part-providing the total while defending their patch in order to survive.

Don't patronise the customer: we must learn from the pattern of use and apparent misuse. NHS Direct should meet general needs in one informed local base. That way it stands a chance of meeting a community-based need. Funding, management and strategic focus should enable and encourage that need to be delivered appropriately.

Bernice Baker,

Freelance nurse consultant,


West Sussex.