In 1998, the Secretary of State approved nine PMS pilots to offer 'nurse-led' primary care. They were designed to maximise the use of nursing skills and to allow nurses to exercise leadership within the primary health care team. This report describes the experiences of the nine nurse leads as they have developed their pilots. After two years of the pilots, there are a number of lessons to be learnt: nurse-led care is not simply a description of the role of nurses but describes a culture of professional equality and patient-focused services; this new model of care has created some local controversy and hostility from doctors, but has nevertheless managed to negotiate a new doctor nurse relationship within primary care and with hospital colleagues; nurse-led pilots have tended to serve vulnerable populations, often poorly served by general practice, which raises the spectre of a two-tier service with the disadvantaged receiving their care from nurses and the mainstream population from doctors; current NHS and welfare regulations are not sufficiently sensitive to the new role of nurses and need review; and a new infrastructure is required to support new nursing roles. [SMD]