Summary The risk of venous thromboembolism (VTE) associated with cumulative flying time remains uncertain. In a case–control study in general practices throughout the UK, participants comprised 550 VTE cases identified from practice records and 1971 age‐ and gender‐matched controls. Participants returned identical questionnaires asking for information including air travel details. Compared to not flying, cumulative flying time >12 h within the previous 4 weeks was associated with a threefold increase in the risk of VTE [odds ratio (OR) 2·75, 95% confidence interval (CI), 1·44–5·28]. Those who had flown >4 h in a single leg in the previous 4 weeks had twice the risk of VTE (OR 2·20, 95% CI, 1·29–3·73). These risks were no longer evident by 12 weeks and were similar to those of day‐case or minor surgery (OR 5·35, 95% CI, 2·15–13·33). Equivalent risks for moderate and high‐risk surgery were over 30‐fold (OR 36·57, 95% CI, 13·05–102·52) and 140‐fold (OR 141·71, 95% CI, 19·38–1036·01) respectively. The temporary nature of the association of cumulative and long‐haul air travel with VTE suggests a causal relationship. The risks of VTE in those with a higher baseline risk due to surgery, previous VTE or obesity are further increased by air travel.

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Improving access to medical advice by telephone may reduce unnecessary consultations, limit interruptions through the day and provide a more flexible service to meet patient needs. We advertised and introduced a daily advice line for patients and found that it was used appropriately and to mutual benefit.

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Important changes are taking place in the provision of out-of-hours and urgent care. Jeannett Martin reports on discussions at a recent conference on urgent care

There have been significant changes to the NHS during the three terms of this Labour government. These have included The NHS Plan (Department of Health (DH), 2000), which established increased access and choice for patients; the national service frameworks, which have set standards for key areas of care; and the new General Medical Services contract (British Medical Association and NHS Confederation, 2003) which was implemented in April 2004. All of these developments have impacted on the role of clinicians working in general practice.

This article outlines the government's changes to the way that primary and community health services will be commissioned and provided. It also discusses the opportunities that exist for nurses to lead and develop services for the benefit of patients in the implementation of changes.

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