There is some serious heart-searching in this month's BJGP. Managing general practice by the performance indicators in the QOF comes under attack in the piece by Jonathan Richards on page 376. Helen Lester, who remains overall in favour of the process, has some concerns over the long-term effect of the formula on the way that general practice will be seen by future generations of medical graduates (page 376). But it's difficult to predict what general practice will look like at all in the next generation. Edin Lakasing on page 380 is worried about the direction that employment patterns have taken, and the effect it will have on patient care: ‘… what gain is there in fretting over the quality of out-of-hours services, or advancing the cause of easy patient access to their health records when we cannot guarantee reasonable daytime continuity of care? The risk to general practice is that patients may indeed conclude that their …