TY - JOUR T1 - Dismantling general practice JF - British Journal of General Practice JO - Br J Gen Pract SP - 860 LP - 861 VL - 57 IS - 544 AU - Roger Jones Y1 - 2007/11/01 UR - http://bjgp.org/content/57/544/860.abstract N2 - Twenty years ago general practice in the UK was frequently and justifiably described as the jewel in the crown of the NHS.1 GPs led primary health care teams which provided comprehensive, continuous, coordinated, and personal care for registered patient populations, and exercised a benign gate-keeping role by regulating patients' access to more sophisticated and expensive facilities in specialist (secondary) hospital care. The work of Starfield and others indicated that an effective primary care system is an essential ingredient of a cost-effective health service;2 for many years the NHS provided a good standard of medical care to the entire population for a relatively small proportion of gross domestic product.3,4Despite the rhetoric of a ‘primary care led NHS’, a number of distinguishing features of general practice have now been progressively eroded or have disappeared altogether. Examples include withdrawal from 24-hour responsibility for patient care, cessation of weekend opening of surgeries, a decline in personal continuity of care and in levels of domiciliary care, and the introduction of contestability and alternative primary care providers. There have also been changes in the traditional gate-keeping role of GPs, through the introduction of alternative ways of accessing care, such as walk-in centres and NHS Direct.5 The introduction of GPs with special interests, discussed in this issue of the Journal by Gérvas and colleagues, represents a further change in the orientation of primary care, the impact of which is yet to be fully evaluated.6Sir Ara Darzi has now published a report on health care … ER -