ABSTRACT
Primary care is the nearest experience to reality which the health industry offers. The pressures of service delivery are set close by the tensions of modern private living. The 1966 general practioner charter created subsidies for group practices, larger and better equipped premises, and the employment of other primary care staff. The 1966 changes were regarded as progressive and with relief by general practitioners. The National Health Service reforms of 1989 and 1990 created fundholding and continued with the general medical services subsidies from 1966. The problems with agreeing on methods and standards for records are an illustration of the problems facing practices across the management agenda. Abraham Maslow's theory seems very useful in the work situation, mainly because it explains why workers' needs never seem to be entirely satisfied. Creating conditions for survival, safety, increasing self-esteem and developing cognitive skills is pretty much an essential prerequisite to primary care taking on the challenge of clinical effectiveness.
