ABSTRACT
This chapter focuses on the medical practitioner in general practice, the most significant single player historically in primary care. Personal administrators have been replaced by general management, and extended primary care means an emphasis on new community-based specialisms, often as alternatives to family medicine. In global terms, family medicine is now practised within six forms of organisational development. Where the extended general practice is professionally oriented in its approach to family medicine, the managed care enterprise is firmly functional. The former will still lay claim to a normative commitment from its participants. In the managed care enterprise this commitment is unequivocally calculative. Accordingly, for family medicine in a district health system, the orientation is bureaucratic with modern managerial values. Accountabilities are formal and prescribed with delineated lines of executive control and cross-agency links.
