ABSTRACT
This chapter describes some of the traditional strengths of general practice in the UK National Health Service. There are major changes underway which have the potential to strengthen generalism in Scotland in the future. The close relationship with families over decades and generations is the strength of UK general practice. Although outcomes have undoubtedly improved more recently as a result of the mass delivery of effective interventions, the greater efficiency observed by Barbara Starfield was more likely a structural effect based on the activities of all practices, gatekeeping with and without gates. There is similar uncertainty with respect to treatment. Evidence-based medicine only goes so far. Despite their internal rigour, randomised controlled trials are often biased by systematic exclusion of complicated patients, practices and places. In general, about a sixth of patients account for 50% of consultations in general practice.
