This article identifies the reasons for the accelerated development of nurse led services and attempts to define and discuss the diversity, risks and future that lies ahead. Evidence was collected and analysed using a literature review, reflection on practice and results of a local survey. It is suggested that nurse led developments are influenced by NHS policy, the practice environment, local need 'service gap' and provision of resources. No clear definition of a nurse led service is revealed, but six key features can be linked to common activities. Partnership with doctors is important and three levels of practice with differing degrees of autonomy and independence are identified and linked to the six common activities. Current scope and future opportunities for services are considered, highlighting the need for good preparation and supervised practice to minimize the risk of isolation. It is suggested that 'low risk' or tightly defined areas of practice may be most suited to this type of development. Our view is that nurse led services may not have reached their full potential and contribute to the future delivery of modern health care. It is concluded, that greater emphasis on education, training and support for nurses delivering this type of service is required to maximize potential opportunities and foster competence.