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The author considers how a policy initiative should call for a shift in the balance of services from the hospital to the community by: a shift in the paradigm to see the National Health Service as an instrument for improving the health of the population and recognising the importance of primary care in such an effort; a shift in the mutual understanding of the professionals who work in the hospital and community based health care sectors; and a shift in understanding and confidence about what types of medical care can be delivered in which settings by which kinds of health professionals. Four levels are also described which could accelerate primary care development. 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