Hi everyone - the old days are not what they were. When I started my current job, I agree that quite often, a single-handed GP had a manager/receptionists who was often his wife, who as often as not was the nurse as well. In the past 14 years I have seen general practice change from the sort of Dr Finlay model which some of you describe, to highly efficient businesses employing well qualified nurses, and professional practice managers. You would not believe the amount of targets and quality measurements every GP practice has to live up to these days - and has to demonstrate and be audited on, otherwise they don't get the quality and performance payments which some of you have mentioned as being GP salaries. The money the GPs get from the PCTs are all performance-related and have to cover staffing and establishment costs, insurance, you name it to do with the business. The new structures being proposed will mean that the funding for the NHS goes down to local level, local groups of GPs commissioning services for their own patients instead of being commissioned by the PCTs. My own GP and practice nurse will do email consultations as well as speak to you on the phone - but many practices now have triage processes where patients are filtered to try to assess urgency - otherwise they just can't cope. We expect a lot of our primary care practitioners - long may they continue.