Two years ago, when he was still BMJ editor, Richard Smith asked: 'What is it that doctors offer that other professionals cannot?' 'Diagnosis, diagnosis, diagnosis, ' responded chief medical officer Professor Sir Liam Donaldson.

Thirteen years ago, working as a single-handed GP, I would have disagreed. However, I now acknowledge that my management skills are deficient, my book-keeping chaotic and I am less rigorous than others in following protocols for management of long-term disease.

In common with many GPs, diagnosis is what I do best.There are now strong arguments in favour of nurses taking a lead role in managing long-term conditions and for pharmacists to take on medicines management.

However, suggesting that primary care professionals are a homogenous group that should 'trade down' to the cheapest option is inappropriate.For example, some PCTs are seeking to use nurses in preference to GPs across areas such as assessment and treatment without considering the evidence for such change.

Nowadays the issue is not who should do what, but how greater capacity, improved quality and enhanced choice can be achieved. Many practices faced with improving the management of high blood pressure, elevated cholesterol or diabetes are moving away from traditional approaches.