The NHS Alliance has issued a damning verdict on how primary care trusts are treating specialist doctors working in the community.
The medics feel isolated and ignored, it claims.
The culture shock of moving from the intensity of a hospital to community work is profound.
Even the most sensitive PCT could struggle to manage the move successfully with the right professional and personal support.
But the fact that poor management of specialist community doctors is widespread is a significant blow to the ideal of moving more care out of hospitals and closer to home.
As the alliance points out, the experience of those doctors who have had the courage to make the move hardly encourages their erstwhile colleagues to follow suit.
If this disparity between experiences in the two fields continues, in a few years primary care will have undermined its ability to attract the best doctors.