The immediate task in primary care is to respond to patient demand. In the absence of other influences, the resulting system of care tends to be both inefficient and inequitable. Primary care has been shown to be increasingly capable of making important contributions to public health, however, by delaying or reducing the complications of established conditions, and by reversing risks in people who are otherwise well. Increasingly, quality of care depends on continuity of care with better communication and cooperation between all concerned. Whether such possibilities are realised depends on the nature and volume of publicly funded support for education and training in primary care, and the types of support given for decisions taken at many levels. Greater integration is needed within primary care to improve its internal effectiveness and efficiency, and as a basis for better integration with secondary care. Primary care needs to be cultivated rather than managed, because of the complexity and importance of clinical decision-making at this level, and because of variations in the needs of individual patients, and local populations.