ABSTRACT
Introduction
In a review of research in the field of general practice (Royal College of General Practitioners, 1970) the authors noted that 'in order to improve the ways in which we work it is necessary first to know how "work" in general practice is carried out'. The review covered many studies of work in general practice but generalisation was made difficult by problems of definition, and hence of comparison, and by a lack of information on certain aspects of practice, notably variation in work-styles. Richardson et al. (1973) found daily consultation rates in 142 practices varying between 31.6 and 7.6 per 1,000 patients and concluded that although variation is 'largely due to the attitudes of patients and this in turn will depend, amongst other factors, on what patients have come to expect of their personal doctor ... our findings point strongly to the doctor himself as the major source of variation in consulting rates' (p. 141). Other aspects of variation have also been documented, e.g. the use of antibiotics in the treatment of respiratory illness (Howie et al. 1971); home visiting patterns (Marsh et al. 1972); referrals to outpatient departments (Scott and Gilmore, 1966; Forsyth and Logan, 1968). Research carried out by our colleagues at Aberdeen into abortion, family planning services, male sterilisation and adenotonsillectomy has also shown up to ten-fold differences between practices in their hospital referral rates.2
