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The state of general practice—not all for the better

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.a172 (Published 05 June 2008) Cite this as: BMJ 2008;336:1310
  1. John Howie, emeritus professor, University of Edinburgh,
  2. David Metcalfe, emeritus professor, University of Manchester,
  3. John Walker, emeritus professor, Newcastle University
  1. Correspondence to: J Howie john.howie00{at}btinternet.com

    The 60th anniversary of the NHS is an opportunity to celebrate its many achievements—both in hospitals, in the treatment of life threatening and seriously disabling disorders, and in general practice, in the development of an effective and efficient primary care service. Together with many others we have contributed to the renaissance of general practice in the United Kingdom after the 1966 charter, through our involvement in the establishment of general practice as a research based discipline in universities with properly structured postgraduate training.

    However, we wish to express a number of worries we have about potential harm to the care of patients and to medical education that, we think, is an unintended consequence of recent reforms. Our starting point is a statement of what we think needs to be safeguarded: the distinguishing feature of UK general practice before the 1990 contract was the long term relationship between a patient (and often a family) and an individually named doctor, whose clinical training was grounded in the diagnosis and treatment of illness …

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