ABSTRACT
Introduction In the process of modernising the National Health Service (NHS) it remains crucial to develop its workforce, and increasing numbers of general practitioners (GPs) want to work flexibly, including part-time. Many GPs have additional skills because some doctors change to a career in general practice after initially training in a hospital specialty, whereas others have acquired specialist skills during their time working in general practice. 'Portfolio careers' have become increasingly popular, in which a doctor has more than one job that might include contracts requiring specialist skills. Developing the role of GPs with an integrated approach to services across the primary and secondary care interface will improve patient access to specialist services in the community, where previously they would have been referred to secondary care. Developing the roles of other primary healthcare staff can also enhance the management of chronic disease in the primary care setting.
