Yes to traditional values must mean no to fundholding and managerial ambitions

Patients and doctors are actors in a play written by history, directed by culture, and produced by politics. Over recent years, the producer has become increasingly autocratic, ignoring the experience of the writer, the sensitivity of the director, and the expertise of the actors. This has happened in many countries1 but perhaps most obviously in the setting of British general practice.2 The almost simultaneous introduction of a market ideology into the NHS and the imposition in 1990 of the new contract for general practice have been experienced as threats to the very nature of the discipline.3 4 General practitioners have felt bewildered and undervalued and there has been a worrying fall in applications for both vocational training schemes and practice vacancies. Government, policy makers, and managers are perceived as valuing the internationally recognised cost effectiveness of British general practice without understanding the nature of the subtle transactions between doctor and patient which make that cost effectiveness possible. General practitioners are asked to take on more and more and they sense that the real substance of their work is being marginalised.5

Such upheaval is profoundly threatening, …