Forgive, pray, a little nostalgic self-congratulation. I've just come back from the annual meeting of the Society for Academic Primary Care in St Andrews. When Samuel Johnson visited St Andrews in 1773 he found it in decline: ‘Had the university been destroyed two centuries ago, we should not have regretted it; but to see it pining in decay and struggling for life, fills the mind with mournful images and ineffectual wishes.’ Now both town and university (to say nothing of the golf courses) are flourishing, and the architecture seems to have avoided any modern invasion, like stepping back 50 years. At the meeting John Spencer quoted a 1991 paper of mine where I had foolishly agreed to predict what I thought was going to happen in the next 20 years.1 I had forgotten writing this piece, so it was encouraging to see how much I had got right: …