General practitioners' (GPs') recognition of, attitudes towards, and intervention for, excessive drinking and alcohol problems among their patients were assessed in a postal questionnaire survey. Levels of recognition of, and intervention for, excessive drinking by GPs were low. GPs did not routinely enquire about alcohol and had managed only small numbers of patients specifically for excessive drinking or alcohol problems in the previous year. Enquiry about alcohol issues was elicited mainly by physical symptoms or by new patient registrations. Although 83% of GPs felt prepared to counsel excessive drinkers, only 21% felt effective in helping patients reduce consumption. Over the past 10 years, there appears to have been an increase in numbers of GPs who feel that they should be working with alcohol issues, but fewer GPs perceive themselves as being effective in this work. The main barriers to brief alcohol intervention were given as insufficient time and training, and lack of help from government policy; the main incentives related to availability of appropriate support services and proven efficacy of brief interventions.

In a primary care setting the combination of dermoscopy and short-term SDDI reduces the excision or referral of benign pigmented lesions by more than half while nearly doubling the sensitivity for the diagnosis of melanoma.

A primary care led NHS, driven by evidence based practice, needs to build on a firm foundation of research in primary care. As researchers are making increasing use of questionnaire surveys to assess general practitioners' views and attitudes, so response rates to questionnaire surveys among general practitioners are dropping. The reasons include lack ofperceived relevance of the research and lack ofinformation and feedback about it, and researchers need to be more aware of the realities of everyday practice. Approaches that might reverse this trend include monitoring all research activities going on in an area to ensure that practices are not overused, giving general practitioners incentives to participate, and improving the relevance of research and the quality of questionnaires.A strong research culture in general practice is necessary to enable general practitioners and primary health care teams to meet the evolving medical needs of their practice populations.' In the new primary health care led NHS, with the focus on evidence based practice, there is an increased need for research and development. As the balance continues to shift from hospital care to primary health care and community services, the search for information from general practitioners is likely to continue to increase.2 Yet, just when general practice has its greatest opportunity to seize the high ground of policy, there is widespread concern over job satisfaction, morale, autonomy, workload, bureaucracy, recruitment, and retention. Recent evidence suggests that this trend is continuing.! A postal survey in 1995-6 of general practitioners in the Midlands produced an initial response rate of 32% (N Heather, personal communication). Telephone follow up of the non-respondents revealed that 25% felt they were too busy to complete research questionnaires and another 13% never answered questionnaires or routinely threw them away. One practitioner returned the uncompleted questionnaire in its prepaid envelope, enclosing an invoice for £5 to cover his "administrative costs." This may become a more common phenomenon in our market driven health service and would further increase the costs of medical research.

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