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Nurse practitionres work in Sussex in two settings: a) in a minor injury unit in Lewes where they work under strict protocols approved by the parent A&E Dept. As consultant I visit them twice a month an audit a sample of their weekly work. At the Hospital they are supported by the A&E consultants in Brighton and by two GP practices in Lewes. For the volume of work they see it is an expensive exercises but the Lewes Community loves their cottage hospital. B) in the A&E Dept at the RSCH they work again to protocls and seen patients referrde to them by the triage nurse TRiage 4/5 from the Manchest system. They order and interprete Xrays and can referred directly to fracture clinic for follow up. In terms of cost it is cost effective as the times to see the doctor have reduced and patient satisfaction has increased. In absolute terms it is an expensive option. Hoever, getting more SHO's is out of the question and finding good staff grades is almost impossible. Increasing consultnat staff would be even more expensive I feel. Carlos %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%