General practitioners (GPs) are, by name and by training, generalists. They have an extraordinarily wide knowledge base, and, in the course of a morning surgery may deal with all ages from the new born to the elderly, with minor self limiting disease to terminal care, with almost insoluble social problems to major illicit drug dependency, and with clinical problems in every specialty from gynaecology to psychiatry. It would, therefore, be impossible for all GPs to have specialist abilities in all subjects, though many primary care physicians do have in-depth knowledge of certain diseases.

Although GPs cannot be expert in all areas, they should have basic competencies in all the major diseases that they deal with each day. A problem with the musculoskeletal system is the third commonest reason for a patient seeking a consultation in general practice, and these problems account for 15% of all consultations in primary care.1 If such patients could be adequately diagnosed and treated by the primary care team and with the resources within the community, this would reduce some of the pressure on secondary care and leave rheumatologists free to deal with inflammatory and connective tissue disease.