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The spread between the best and the worst of the 10 000 practices in the United Kingdom is wide. In a matter of minutes we can travel from paperless practices with integrated teams which have developed nurse practitioners, physiotherapy, and in house phlebotomy to those where the prescribing is suspect and the consultations perfunctory—all performed with the sole aids of prescription pads, sick notes, and unchecked sphygnomanometers. Like the gap between evidence and practice, there is a gap too between continuing medical education and professional and practice development. Professional and practice development plans aim to fill that gap and are destined to replace the postgraduate education allowance. The concept is a direct result of the Chief Medical Officer's review of continuing professional development in general practice, which adds another surge of energy to the “corporate” rather than the “independent practitioner” vision of primary care. The review was a response to the criticism that the postgraduate education allowance has been based on an educational model which is “didactic, uni-professional and top-down,” rarely involves the …
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Glyn Elwyn (1998) studied this question.
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