Research identifies that on average, 75 per cent of attendances at an emergency department are minor. In terms of policy and dynamic action, this majority is ignored. Yet by fully developing the minor injury/illness service, the pressure on emergency departments would be relieved.

One such successful unit is the MIU service at North Bristol trust.

In terms of sustainability, these units provide value for money and are cost-effective, when nurse-led by emergency nurse practitioners. And "see and treat" and discharge times hover around 60 minutes. So why are MIUs not breaking out nationally?

Well, there are no primary care trust profit margins, there is no glamour in dealing with minor conditions and MIUs can be so effective, GP surgeries may seem inconvenient by contrast.

In truth, I don't know why these units are not expanding and patients being seen promptly, but I do know we have a winner-in-waiting and no-one to champion its cause.

Mark Pittman, emergency nurse practitioner, MIU, North Bristol trust

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