Duncan Sinclair is a strong advocate for placing primary care in a strategically central position as a means of propelling medicare into its second phase. In the United Kingdom reorganizing the primary healthcare system has been a central feature of recent reforms to the National Health Service (NHS). The most recent of these reforms have included the establishment of 481 Primary Care Groups and Trusts, which constitutes a key element in the government's strategy for modernizing the NHS. The signs are that these groups have established clear policies and priorities to carry them forward. They have begun to implement change to deliver better services and improve health. However, progression to a primary-care-led system of care brings new challenges, which require a set of responsive strategies that are no less challenging than those facing a hospital- centred healthcare system.