To the Editor: Your 3 July issue featured task substitution and task transfer. It is a principle of commercial organisation that if a task can be standardised, it can be delegated, automated or computerised, provided there is good central management, supervision and communication. However, I suspect that this is only a part of the new face of general practice, as we are being expected to undertake tasks for which my age cohort (I am 54) was neither trained nor prepared.

Practice administration is far more complex than ever before, and most of the clinical caseload has shifted from episodic care of infections and surgical conditions to the long-term systematic management of chronic cardiovascular, respiratory, musculoskeletal, endocrine, and other illnesses. Diabetes is a good example. Managing patients with diabetes requires high-level skills in practice management and protocol-driven chronic disease care.

I suggest that a basic and fundamental difference between doctors and allied health personnel is that allied health personnel are extremely comfortable with protocol-driven chronic management while doctors, especially of my age cohort, are more focused on detecting and dealing with difference, variation and abnormality in our patients’ health. Rather than force all groups to do the same tasks, is it not better to build on their skills and interests in a logical and structured manner?

General practices are no longer only places where general practitioners work; they are evolving into teams of GPs, other doctors, administrators, allied health personnel and office and information techno-logy staff, who work together in an integrated and coordinated way for the benefit of patients. This provides mutual support, flexibility of work hours and increased job satisfaction for all.

Our practice has been steadily working towards this for the past 20 years.