Intended for healthcare professionals


General practice is making a leap in the dark

BMJ 2016; 355 doi: (Published 28 October 2016) Cite this as: BMJ 2016;355:i5698
  1. Martin Marshall, professor of healthcare improvement1,
  2. Denis Pereira Gray, emeritus professor2
  1. 1Department of Primary Care and Population Health, UCL Sir Ludwig Guttman Centre, London E20 1AS, UK
  2. 2University of Exeter, Exeter, UK
  1. Correspondence to: M Marshall martin.marshall{at}

New models of working risk throwing the baby out with the bathwater

A strong case is being made in many countries that the traditional model of general practice needs to change. Critics claim that practices are too small and too isolated, that they are increasingly unable to meet their patients’ needs and expectations, and are unfit to lead the necessary redesign of health systems.1 2 As general practice in the UK in particular struggles with a demoralised workforce and inadequate resources,3 these criticisms are being taken on board. Quietly but rapidly, and in a largely ad hoc fashion, general practice is changing; small practices are closing or merging with other practices, practice networks are forming, the primary care workforce is becoming increasingly multidisciplinary, and new integrated models of care that bring together community and hospital based services are being developed.

Many of these changes may be good for patients and for the health system, but insufficient attention is being paid to the possible unintended consequences. One substantial risk should …

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