INTRODUCTION
This essay starts from the premise that the phrase ‘in my day …’ so beloved of our teachers may have more significance now that we are undergraduate teachers ourselves. We feel that earlier eras of medicine have something to contribute to younger generations and that recent evolutions are invaluable resources to consider the changing role of primary care in general and academic general practice in particular
We set out to show some of the changes over the last 20 years or so through the eyes of individuals with varying GP academic experience. However, it is not intended to be mere idle musings, because we mean to show that a blend of the good from the past, combined with the good from our contemporary position will improve ongoing academic primary care medicine and teaching.
PRIMARY CARE MEDICINE
The job of a GP used to be more clearly defined; various definitions of general practice were recognised and were the basis of the vocation;1 in Britain being a GP comprised becoming a partner in a practice providing 24-hour care to a defined population and largely being paid by capitation; out-of-hours work was often done in collaboration with other surgeries or cooperatives.
The linking of GP pay to externally set indicators of performance at a population level began with the unpopular 1990 GP contract.2 This changed once more with the present contract and its combination of permitting GPs to opt out of 24-hour care while offering money for quality care as defined by interim, largely population-based outcomes (QOF),3 although this aspect of the contract has debatable utility.4,5 There is even speculation in the media that a new contract may be discussed by the current government soon.6
Twenty years ago, trust was a large aspect of primary care, although some saw …