Sir,Kumar is correct to champion the cause of primary care within India.[1] The reasons for promoting primary care outlined in the paper are sound — however these reasons are not all, there are others. First of all, along with primary care will come more accessible care. Adequate access for patients in both rural and urban areas is vital. Second as the population of India ages, an older population will inevitably have more co-morbid diseases. Older people with multiple co-morbidities cannot attend multiple tertiary care specialists. They must have primary care physicians who will be able to provide generalist care for all their needs and who will also be able to co-ordinate their care. Third care provided by secondary and tertiary care specialists will become prohibitively expensive. It will be too expensive regardless of who the payer is — be it the individual, their family, or the government. For reasons of cost alone, all countries in the world notwithstanding the state of their economy need more primary care. Fourthly more primary care will mean not just more primary care doctors. More doctors alone will not be enough. Patients and the health service will need more primary care nurses, pharmacists and allied health care professionals.The challenge for the health service will be to provide high quality education to produce these much needed physicians. Postgraduate training curricula will need to be developed; means of delivering these curricula will have to be established; postgraduate assessments will need to be put in place; and lastly all of these will need to be rigorously evaluated and subject to continuous quality improvement. The challenges are many yet the potential reward is clear: adequate numbers of high quality health care professionals of the kind that the population needs.