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Dr Louise Hammersley says her combined nurse practitioner/ independent prescriber is so successful locum GPs have to be hired when she is on holiday.

Dr Hammersley, a GP in Lichfield, Staffordshire, said Sandy Reid sees acutely ill patients, leaving her free for more complex cases. 'More patients have been screened for more significant pathologies now, so in some ways it makes our jobs harder,' she said.

Mrs Reid, who has 20 years' experience in A&E, said she could deal with the majority of presenting conditions ­ but she knew when to refer on to a GP.

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