Recent dramatic headlines have claimed that general practitioners will be encouraged to carry out operations such as hernia repairs, carpal tunnel decompression, and varicose vein removal.1 2 The implication is that general practitioners with little surgical experience will suddenly be picking up a scalpel to carry out operations they are not trained to do. Not surprisingly such a prospect has generated much controversy.

The headlines have been prompted by the government's white paper on community services in the English NHS, Our Health, Our Care, Our Say, which proposes a shift in the locus of healthcare.3 The chapter on “Care closer to home” sets out various alternatives to current practice, arguing that patterns of care should adapt to a changing healthcare environment and to the wishes of patients. This means shifting the emphasis towards local services wherever possible. Are the white paper's proposals really as radical as they have been portrayed in the press …