Nursing faces new opportunities and challenges as part of the government’s initiative to introduce Payment by Results. These opportunities arise from increasing demands to work effectively in an environment of intensive customer demand and expectation. The challenge for all nurses is to continue to deliver quality health care while keeping pace with changes to services and organisational responsiveness. It is important that nurses and other health professionals ensure that the needs of patients are not compromised in the pursuit of financial reward and that systems of work are improved as part of this initiative.