How much of primary care should be standardised? The drive for evidence based quality has precipitated guidelines and protocols aimed at setting standards and reducing variation in clinical care. Yet the personal and continuing approach to care, typified by the general practice consultation, sits uneasily with such requirements for uniformity. Some commentators predict that changes in clinical practice towards care based on more formulaic protocols will lead to the disappearance of the family practitioner.1 Others have highlighted the practical and conceptual barriers that general practitioners face when asked to implement the increasing number of guidelines and decision tools.2 However, the central concern driving the idea of standardisation is the frequent gaps and variations between evidence and practice. In the linked randomised controlled trial (doi:10.1136/bmj.b421), Ravaud and colleagues assess the effect of standardised consultations about body weight and physical exercise in patients with osteoarthritis of the knee.

Standardisation of procedures is not uncommon or new in primary care. Routine systematic coding of morbidity and activity has transformed consultation records in general practice. Efficient …