ABSTRACT
During the 18 years of the authors' diagnostic consultancy work there have been significant changes in the overall context in which general practice is delivered. In this chapter, the authors summarize five principle changes: the changing nature of primary care, the developing concept of partnership and team-working, structural and political change, increased accountability and the application of basic management method to clinical care, through the development of clinical governance, and the development of the commissioning role. Primary care today is seen as the way of organising healthcare better through maintaining patients at home or in the community, where it is appropriate to do so, reflecting current social thinking and demand. Teaching general practitioners (GPs) were ahead of the government and the National Health Service (NHS) in exploring the use of audit and quality assurance in the teaching practice setting. The main impact of fund holding was on the practices themselves because of the new organisational and management demands it made.
