The delivery of healthcare in the UK is coming under the intense scrutiny of politicians.¹ Central to their argument is the concept that good quality diagnosis and management can be moved out of large hospital facilities and brought closer to patients. The philosophy behind such an approach is both that it is more user friendly and more cost effective.

This rapid and determined quest for reform means that many of the core traditions and values of the National Health Service will need to be reassessed. For hospital-based consultants and specialists this will present a very specific challenge. Will they need to be based in large hospital units? Should they continue to have a commitment to patients outside their specialist expertise?

Just as acute medicine emerged as a distinct specialty during the past decade, specialist care in the community will be the emergent specialty of this decade. The concept that such care can be provided by general practitioners (GPs) alone is probably unsound because …