Nurses are increasingly being employed instead of doctors in some areas of work. This article examines this phenomenon in relation to a ‘nurse-led’ Personal Medical Services Primary Care Act pilot scheme. As part of an evaluative project, we examined the way in which patients understood and constructed nursing roles in the context of their use of primary care services in a socially deprived area. Whilst professional roles are established to some extent as the result of negotiation between and within professions and with government policymakers, patients' perceptions also affect whether or not changes are accepted, and the extent to which new roles gain legitimacy. Our evaluation took the form of a case study with questionnaires, in-depth interviews and observations. This particular paper is based mainly on data obtained from interviews with patients who had experienced the nurse-led service. The results showed that some patients attributed high status to the nurse by emphasizing that the nurse leading the practice was highly qualified, and other patients reconstructed the role and thought of the nurse as a doctor. This latter interpretation was derived from the patients' descriptions of core activities such as diagnosis and treatment, and other factors such as an absence of uniform. However, the most important factor that affected whether or not patients accepted a ‘nurse-led service’ related to the way in which the service met their needs. This seemed to be more important than perceptions of professional identity. The nurse-led service continued to provide the social support and continuity of care that the patients valued, and which had been provided by their previous general practitioner. The provision of these aspects of care appeared to be more important than whether or not the service was nurse-led or doctor-led. It is important to consider patients' perceptions of policy innovation when establishing new services.
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