ABSTRACT
The promotion of clinical effectiveness in the current environment may be championed by one or more of four constituencies: patients and their representatives, general practitioners and their staff, hospital consultants and their staff, health authorities and other purchasers. Promotion of the genre might take two forms: first, the education of the general practice staff and of the general public; second, the assumption that only specialists can provide effective care, with an accompanying rise in demand for specialist referral which the National Health Service will not be able to respond to adequately for the generation. A number of converging themes hold the key to the future structure and role of primary care. Increasing knowledge, of both disease aetiology and treatment technology, will lead the professions and patients towards more specialist care and its delivery by professionals with specific training and designated status. Clinical effectiveness will be one of the forces for radical change in the way health care is delivered.
