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The NHS in Britain faces enormous challenges. Demand for healthcare is rising dramatically as the population grows larger and lives longer. Increasing pressure on acute services, the growing burden of chronic disease, greater emphasis on screening and prevention, and advances in biotechnology will inevitably lead to spiraling healthcare costs.The Department of Health's White Paper Equity and Excellence: Liberating the NHS addressed these problems with radical proposals for change. It set out plans to create a more responsive NHS, by encouraging GPs to commission the redesign of services around the needs of patients and populations, with potentially significant shifts of activity from secondary to primary care.1 The debate continues around implementation of these plans, but there is no doubt that the changes will have a significant workload impact in primary care.The answer is an unqualified yes. In an increasingly sub-specialised and de-centralised NHS we shall need high-quality generalists more than ever to provide coordination and continuity for patients; to manage risk, uncertainty, and cost; to lead service redesign through commissioning; and to work in partnership with other health and social care professionals. The Department of Health expects that 50% of newly qualified doctors each year should be recruited to general practice,2 but can we be sure that there will be a sufficient number of appropriately trained GPs available when we need them?This month's …

Future-proofing primary health care: GP recruitment and retention in the new NHS