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A balance is needed between central control of primary care and local autonomy. The aim should be to maximise local autonomy but conform to central policies and guidelines where appropriate. The British NHS has mistakenly tried to exercise strict control of professionals ('centralised micromanagement') and this has seriously eroded mutual trust and innovation. Self-organising systems involve circular processes that exist widely in nature, and primary care has the potential to be much more autonomous if feedback loops are developed at local level. This paper describes and discusses ways of enhancing self-organising and learning in primary care, in which new and emerging information technology will play a major part.

161 inches. X-ray of the skull is normal and shows orbits of normal size. Beyond the eye condition, which is as described above, examination reveals only a small hemangioma in the right pubic region and pallor of mucous membranes (R.B.C. 5,000,000 per c.mm.; Hb 6-6 gramme per 100 c.cm. (48 %); C.I. 0-49). Blood Wassermann negative. This is a case of bilateral retrolental fibroplasia in a premature small baby, complicated by general failure to thrive, anxmia, feeding difficulty and marked delay in behaviour development. No unusual drug or vitamin treatment was given to either the mother or the baby. The baby, like so many small premature babies, spent much of the first weeks of life in an oxygen tent. Examples of this condition have been recorded in England during the last seventy years (Nettleship, 1873). The late Dr. Terry of Boston (1942) first drew the attention of pediatricians to the association with prematurity. Although relatively common in Boston this is still a rare disease in and around London.

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A discussion group course for treatment-room nurses was organized in the spring of 1971 by the Thames Valley Faculty of the Royal College of General Practitioners. Twenty-eight nurses took part. Some were from local authorities but most were privately employed. Questionnaires were completed by participants. The course has had several consequences, and it is felt that some form of specific training for this branch of nursing should be established.