EDITOR—Elwyn's editorial about professional and practice development plans for primary care is at best confused and at worst dangerous.1 He comments that there are good and bad practices and points to the difference between the (apparently) good and the (obviously) bad. The good are paperless, with nurse practitioners, physiotherapists, and on site phlebotomists; the bad are those where consultations are perfunctory, prescribing suspect, and the sole aids are prescription pads, sick notes, and unchecked sphygmomanometers.

What evidence does he have that being paperless or having a nurse practitioner leads to better patient care? My practice has an on site physiotherapist, but this doesn't make us a better practice, just slightly more convenient for patients. Neither does our computer make us a better practice. This false logic is part of an insidious trend: if you don't have all the above trappings plus a nurse facilitator doing your audit and a business plan then you're no good. I'm sure that patients don't see it this way. The truth is that however much academic general practitioners try to tinker with general practice, with their talk of practice development, the patients will still be there with the same problems, and it is our job to be available and accessible, to listen, diagnose, treat, or refer and to give appropriate support. Elwyn fails to mention any of these things, which are more important than the esoteric matters with which he is preoccupied.

Why do we need practice reaccreditation? We've all passed our exams after years of hard work, and, except for a small number of black sheep, we're all doing our best for our patients. Lawyers, accountants, engineers, architects, dentists, and vets aren't flagellating themselves in this way. Voluntary “personal learning plans” are OK if you want them. I know that the meetings that …