choices. Alas the government's direction is a triumph of ideology over evidence. Moreover, it ironically strengthens the hand of gps in precisely the way that will preclude more pressing changes needed in the UK, notably bridging the gap between health and social care and dealing more effectively in the long run with chronic disease, dementia and mental illness, obesity and inactivity and supporting the frail elderly and their families. A great story but it's always dangerous to extrapolate what works in one area and impose it on everywhere. It also occurs that doctors are a mixed bunch; few doctors like telling patients bad news and most resent budget limitations.