I joined the Corinthian surgery in Cheltenham (figure 1) as a general practitioner (GP) 19 years ago. The practice was located in a four-storey Georgian town house, called Weston House (figure 2). It did not quite fulfil the description laid out by Collings in his shocking description of general practice in the 1950s1 “An ill-adapted annex to a private house, the waiting room… small, cold and inhospitable and in peak hours overcrowded and trailing queues in gardens or streets. The consulting rooms a jumble of untidiness serving every imaginable purpose without regard for comfort or privacy.” However, Weston House was showing signs of wear: the basement was damp, the stairs creaked alarmingly under the heavier patients and my desk was (occasionally) a jumble of untidiness. There was no disabled access and as a result, we sometimes gave car park consultations. In 1999, together with four other practices, we moved to purpose-built accommodation: The St Paul's Medical Centre (figure 3).

UK general practice has changed dramatically since 19 years ago. At that time, information technology was a computer with a green screen that did little more than print prescriptions (if you were lucky). Now all patient records are stored, tests are ordered and results received electronically, we have a practice intranet with a plethora of guidelines and access to the internet. In 1994 we still did all our own on-call, covering our patients 24 hours a day, 365 days a year. It was a relief to give this up 9 years ago. However, the UK Department of Health's recent decision to review out-of-hours care suggests that the 24-hour commitment may be returning our way.2

Primary care was …