Cost, equity and access are a trinity of priorities that challenge all healthcare systems. Control one and the chances are that the impact on one of the others becomes unacceptable. The NHS reforms aim to regulate all three through a complex web of checks and balances, market forces and local decision-making. Whilst much attention has been focussed on changing the structure of the commissioning landscape in order to influence this trinity, a real revolution has gone on very much more quietly. The work of a general practitioner today may seem the same as that of 20 years ago but the methodology for managing patients is entirely different. The traditional model of …