Advances in most medical disciplines are usually characterised by the emergence of new technologies and therapeutic discoveries. In general practice, however, recent advances have been more oriented towards the introduction of radical new organisational structures, internal systems, and methods of technological transfer.1 These developments are shaping new roles for general practitioners within their health services.2 Many of these changes have been driven by governments keen to control the spiralling rise in health care costs.

In many countries the increased importance being attached to the primary health care sector is reaching new heights. The example par excellence is the United States, where we are witnessing what amounts to a rebirth of the family physician.3 This seems almost ubiquitous - at a time when most of the major disciplines in medicine are being increasingly dominated by rapid technological advances in genetic engineering and molecular biology.

The Clinton administration, amid a climate of rising health costs generated by the demand for new technologies together with the growing threat of medical litigation, has proposed extensive reforms of the American health care system.3 If these reforms are successfully implemented, the primary health care sector will be placed firmly at the base of the system, with a crucial gate keeping role to regulate access to the high cost secondary and tertiary sectors. The impact of this major policy shift is likely to be far reaching and provide a role model for a number of other countries to follow.