Clinical governance and Health Improvement Plans (HIPs) targeted to patients primary healthcare needs are central to the British government s NHS reforms. The reforms obliged Primary Care Groups (PCGs) to heed public concern over poor professional standards in the provision of NHS services. Real data on the impact of the reforms is limited. The data presented here is novel. It provides an annual assessment of the reforms effects on primary care from the perspective of the patients doctors, the General Practitioner (GP). OBJECTIVES: To determine how PCGs are responding to the needs of GPs patients, and whether these needs are being attended to better now than previously. METHODS: In November 1998, the Primary Care Rheumatology (PCR) society mailed each of its members a questionnaire to assess the impact of the Primary Care Act on musculoskeletal care. A follow-up questionnaire was mailed in November 1999. Using Microsoft Excel, the numerical data was quantified as means, medians or ranges, whilst free text answers were summarised using categories based on the responses. RESULTS: In November 1998 few HIPs were concentrating on a prime area of concern to patients, musculoskeletal care. In 1999, a gulf still exists between health authorities perceptions of patients needs and what GPs first-hand experience tells them. GPs financial pressures are also growing and increasingly affecting PCG drug budgets. CONCLUSIONS: GPs are struggling to cope with the speed and scope of the reforms, with patients needs going unmet. With the current explosion in new musculoskeletal medicines, the growing financial pressures will be of concern to patients, politicians and the pharmaceutical industry.