Prime minister Tony Blair made his first foray into the health service since last year's NHS 50th anniversary this week (see news, pages 2-3). His appearance to launch 20 new 'walk-in centres' and announce a dramatically widened NHS Direct demonstrates how seriously this government takes primary care reform.
What started out as something of a gimmick with a few NHS Direct pilots dealing with a handful of people at a relatively high cost has now become the centrepiece of the reforms. Piece by piece, ministers are unpicking primary care and general practice as we have known it for decades. The doctors' monopoly is giving way as nurses take on a more central clinical role, services are coming under non-medical management for the first time, and even contractor status is crumbling.
None of this is to suggest that doctors need to feel threatened. Their role in primary care groups and trusts, for example, should give them a broader influence over policy direction than they currently enjoy.
But encouraging though many of these developments are, what we so far lack is an end point - even one a decade down the line. The time has come for ministers to abandon the piecemeal approach and set out their long- term vision of the reformed NHS and the steps that will get us there.