Introduction

In 1999 general practice directly cost the British taxpayer about £3 billion. Prescriptions for drugs cost about a further £4 billion and general practitioners (GPs) referred 11 million patients to hospital with considerable financial consequences for the National Health Service (NHS). In short, general practice is big business. Yet this key public service has hardly been managed in any direct way at all. Instead it is provided by some 30000 practitioners working in nearly 10000 practices. These small organisations have typically been under-managed and under-capitalised when compared both to hospital care and to other systems of primary care in the developed world.