Primary care has been the subject of a quiet revolution in recent years, with the ending of the monopoly of provision by independently contracted GPs and the introduction of a range of new targets and new forms of first contact care. Now it is poised for further radical change with reforms to the structure and roles of primary care trusts and the introduction of practice-based commissioning and competition between primary care providers. This paper examines the potential impact of these changes and the role of primary care in the new NHS market, outlining some of the main challenges and suggesting possible ways forward. [Summary]