As medical care becomes increasingly complex it is inevitable that those involved in delivering the care will require specialist and sub-specialist expertise. In some medical specialties, particularly those which do not figure prominently in medical undergraduate training programmes, it has not always been possible to match up the demands of the service with the training requirements and clinical skills of those employed to provide the service. In the field of neonatal medicine such a mismatch has been apparent for many years and, in an attempt to help redress the situation, in 1991 the UK's first 'Advanced Neonatal Nurse Practitioner' course was established in Southampton, as a result of an initiative sponsored by the former Wessex Regional Health Authority. The course was validated by the English National Board (ENB) for Nursing, Midwifery and Health Visiting and subsequently given the designation 'ENB A19'. The educational and professional basis for the course, and details concerning its structure and curriculum, have been reported. 1,2 The first intake comprised 7 experienced neonatal nurses from 6 centres in the former Wessex region; the next year a further 8 nurses from Wessex successfully completed the course, together with one from a neighbouring region; in the third year nurses from units in Edinburgh, Liverpool, Coventry, Wolverhampton, Northampton, Chester and London, as well as another 4 from Wessex, were enroled. The course is now in its fourth year and, by the end of 1995, it is anticipated that there will be about 46 qualified members of this new profession distributed throughout the UK. At least one other course, in the