Primary care, for so long denied the pleasures of NHS reorganisation, is finally facing a showdown. At risk is the deal under which primary care is supplied by general practitioners (GPs), who combine public service and private entrepreneurship within a protected market.

The private sector is being invited to tender for polyclinics and for primary care services across England. GPs complain that these changes have been sprung on them with little warning. Who voted for polyclinics, they ask, or for open tendering for primary care services and the awarding of contracts to private companies? GPs feel that they have been sandbagged by a reform that lacks political legitimacy or an evidence base.

The British Medical Association has launched a Support your Surgery campaign, while Ara Darzi, the health minister, has promised local people involvement and consultation in any changes to their services.1 But this promise has been made when the changes are already under way.

Lord Darzi’s principles are positive (box), says Hamish Meldrum, chairman of the BMA Council. “In fact they’re impossible to disagree with. Of course it’s right that changes should always be to the benefit of patients, that they should be evidence based, and that local populations should have a meaningful say over their NHS services. The problem is that the public and healthcare staff alike have yet to see much evidence of these principles being delivered up to now.”