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General practitioners in Italy work as independent contractors in a national health service. There are, however, many differences between Italy and the United Kingdom regarding the status, contract and culture of primary health care. The similarities and differences offer valuable insights into the benefits and disadvantages of the position in the UK, and serve to highlight the significant gains made in the past 30 years. This account of Italian general practice is based on the author's personal experience gained during a one month sabbatical visit to Italy in 1990.