A final g'day to English general practice.

Patients becoming ill outside fairly standard office hours are no longer assessed by their doctor or his or her partner. Patients in many parts of the country can choose primary care walk-in clinics if this is geographically or otherwise more convenient for them than their registered practice. Within their own practice, patients may see different practitioners (and sometimes nurses rather than doctors) for different chronic diseases (for example, asthma, diabetes, and ischaemic heart disease), or indeed different practitioners for episodes of the same acute or chronic illness (because this is the easiest way to provide the flexibility of practice appointment provision in response to the consumerist diktat of government for patients to be seen quickly after their request for an appointment). Extra appointment capacity within practices (but not usually with the patient's 'usual doctor') has been recruited to make sure that Quality and Outcomes Framework (QOF) targets are met. Some fairly basic services previously provided by GPs have essentially been hijacked by other providers (antenatal obstetric care by community midwives or hospital clinics and drug abuse by specialist primary care services, for example). Also gone are the cosy personal and red tape-free lines of communication between GPs and other primary care professionals and secondary care practitioners (wither the Leeuwenhorst 'He will practise in cooperation with other colleagues, medical and non medical'). 3 I left a practice in 1999 where the district nurse, community midwife, and health visitor all worked from the practice premises and served the same (practice) population. Formal meetings occurred regularly but even more important were the informal meetings at morning tea breaks or even in the car park. Mutual concerns about patients were exchanged face to face and respectful and trusting professional relationships were developed. We understood each others roles and primary concern for patients BACKGROUND