By Dr Michael Dixon The past year has been dominated by strategy. The Darzi Primary Care Strategy gives us a good plan for primary care. It includes many of the ideas in our own report earlier this year "In Sickness and in Health". The NHS likes its plans but a plan, a plan of action and the action itself are three entirely separate things. And of the three, it is only action that speaks. Particularly in these troubled economic times, when the role of primary care is ever more urgent and important. Poet T. S. Elliott warned “Between the vision and reality falls the shadow”. Today there are four shadows of disparity and disconnection, that we must understand, recognise and sort if we really want to bridge the vision and the reality of current strategy.