It is in itself an interesting fact that during the past decade there has been an increasing volume of studies and reports on general practice in Britain, the United States and other countries. No doubt much of this interest has been provoked by the growing impact of scientific developments on medicine over the same period. These have raised many questions about the present state of general practice; its historical evolution, and its future place in medical care. From these various studies, official and unofficial, one general conclusion does, I think, emerge.

For many years before 1948 the general practitioner in Britain had been socially and professionally isolated from the broad stream of developments in medicine, public health and social welfare. His education for general practice had been neglected. He was assumed, by consultants, to be something of a mediocrity. In a period when medicine was becoming less of an art and more of a science he was sometimes forced to behave, by the rigours of competition, in ways that contradicted the logic of scientific advance. In a period, too, when the potentialities of diagnosis and therapy, in their social as well as their medical components, were rapidly expanding and demanding more teamwork, more co-operation, the general practitioner remained, more often than not, a single-handed, professionally isolated, private entrepreneur.

Moreover, the relatively low level of financial rewards for many practitioners before 1939 added to the frustrations of an often unsatisfying professional life. Attitudes to medicine and to their patients which many were, in consequence, led to adopt found their expression in the physical environment in which they chose (or were compelled) to practice medicine. It was an environment which spoke loudly of neglect, voluntary or enforced; of an unrecognized, inert acceptance of low professional standards. This was the situation which the National Health Service inherited and made manifest in 1948 to the first investigators and to the middle-class patients who now began to use the general practitioner's waiting room.

Some reasons have already been given to support the belief that, since 1948, there has been an improvement in the standard of general practice. The long process of social diagnosis, which has been a feature of this period, may in itself have helped towards something of a spontaneous recovery.