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The substitution of primary for secondary care is progressing at a fast pace, yet there has been little evaluation of the appropriateness of such a fundamental change in health service organization. The aim of this paper is to raise some issues for discussion about the contribution of economics to future research on the substitution of primary for secondary care. Given the central role general practitioners (GPs) will play in a "primary care led' National Health Service, the paper concentrates on the replacement of secondary care by GP-based services.

Primary or secondary care? What can economics contribute to evaluation at the interface?