Over the past two decades, general surgeons have evolved and subspecialised. It is no longer plausible for a consultant to label him or herself as a true general surgeon in the traditional sense of the term. For example, a surgeon is very unlikely to have the training and experience to operate on all aspects of the gastrointestinal (GI) tract while still maintaining adequate skills in oncoplastic breast surgery and vascular surgery. To maintain adequate skill and up-to-date knowledge, it has become necessary for surgeons to focus on one area of general surgery, declaring an interest in that subspecialty while continuing to serve as a general surgeon for the purposes of the emergency on-call provision for general surgery.It has become necessary to centralise major and relatively infrequent specialist procedures in tertiary referral centres.