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A good and timely intervention in the debate and primary care. There is more to add on the burning platform argument of current primary care delivery such as the phasing out of MPIG, the review of PMS and Primary Care's inability in its current form to stem the growing numbers of emergency admissions to hospital. The shift from infections and heart disease in 1950s as being the 'killers' to long term conditions, cancer and cardiovascular incident survivors in 21st century also adds a burden to primary care which it struggles to shoulder. The shift towards larger practices is not primarily about commissioning and contracting (although this needs addressing too) but about managing the burden of disease in individual patients making best use of skills and resources that primary care will need to deploy.
charles waddicor