The UK healthcare think tank the King’s Fund has just published the report of its independent inquiry into the quality of care in general practice (BMJ 2011;342:d1833, doi:10.1136/bmj.d1833). At the start of the inquiry, back in 2009, the fund commissioned a number of research and discussion papers that go a long way towards setting out the immense complexity of measuring quality within the increasingly chaotic context of today’s NHS. It is therefore disappointing to discover that the final report is somewhat superficial. However, not the least of its contributions may well turn out to be the way it manages to underline, albeit unintentionally, how intensely difficult it is to undertake the general practice care of patients day in and day out. For this reader, the report achieves this in three different ways: by presenting out of date scientific evidence, by fudging the discussion of continuity of care, and by the politically correct pretence that all patients are reasonable.

Every day, general practitioners face the challenge of keeping up with developments in biomedical science across the entire range of disease. This is an almost impossible task but remains a professional responsibility. The inherent problem in guidelines and payment for …