Interest in the role of the nurse practitioner in primary care, as first point of contact for patients with acute illnesses, is well established. Recent studies in the UK have examined the role in the context of a variety of acute presentations and have addressed issues of competence, safety and patient satisfaction. The management of acute presentations involves responsibility for making a diagnosis and, frequently, for recommending medication either on prescription or to be purchased from the pharmacy. As the nurse practitioner role develops in primary care there is a need for evidence of the effective management of specific acute presentations. Protocols have been advocated as a key to the successful introduction of the nurse practitioner role but the legality of their use, particularly in relation to prescribing, remains unclear. The aim of this study was to compare, in one general practice, the management of acute urinary symptoms by nurse practitioners with that of GPs in the context of a protocol. The study was undertaken in two parts: a retrospective analysis of a sample of the records of female patients followed by a patient satisfaction survey. The retrospective analysis examined the use of the protocol in guiding the decision-making of both groups of practitioners and evaluated the outcome for the patient. The outcome indicator used in this part of the study was the need for a repeat consultation within 14 days due to non-resolution of symptoms. The retrospective analysis of records was supplemented by a patient satisfaction survey. In comparison with the GPs, the nurse practitioners' records were more complete, the prescribing rate was lower, the use of laboratory resources was similar and there was no difference in the number of patients who needed to be seen again. In the patient satisfaction study higher levels of patient satisfaction were achieved by the nurse practitioners.