General practice and palliative care

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Abstract
The paper by Meijman, published in this issue of the Journal, is of importance on a number of counts.1 It provides a description of the work of general practitioners in seeking to help people with HIV disease. Doctors working in areas of apparent low prevalence of HIV infection may be surprised by the central role which doctors in one general practice in Amsterdam have played in all phases of the disease. The HIV epidemic has been uneven in its geographical distribution, with marked variation in the groups infected. This has tested the effectiveness of primary health care teams in different ways in different centres. In the United Kingdom, in spite of the uniform structure of the National Health Service, the initial response to the HIV epidemic showed major differences.2 The pattern of care in London was initially hospital based, with community care for people with HIV disease organised through systems of hospital outreach. In contrast, general practitioners in Edinburgh developed services for people with HIV disease in a shared way with specialist colleagues. The shared approach in Edinburgh related to the fact that most of the early cases of symptomatic HIV disease came from a group of young injecting drug users. As in Amsterdam, a number of these young people rejected referral to specialist centres, and general practitioners had to acquire the skills to manage the serious manifestations of the disease in the community.

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