Independence days: The practice based structure of general practice is ideally suited to modern primary care

Education and debate p 797 The creation of primary care trusts has raised the prospect, as perhaps never before, of a substantial shift from the independent contractor status of general practitioners to that of salaried employees. This is not a policy objective, but the forces for change cannot be underestimated and are causing serious concern among most general practitioners.1 The proposed structure, governing arrangements, and powers of primary care trusts will allow the transition to employed status with greater ease and perhaps persuasion. Equally, there are some general practitioners who see employed status as an answer to the responsibilities of on call work and equity purchase and in any event not core to a general practitioner's primary purpose.1 The debate is often ideological and political; we want to examine the concept from evidence based principles of organisational design and behaviour. Theory about the genesis of organisational structure has long focused on environmental uncertainty and complexity as key concepts that mould structure.2–4 Briefly, the more stable an environment, the more rigid the structure, with a list of rigid policies relatively unchanging. …