General practice’s research base in the 1980’s can now be seen to have been remarkably underdeveloped – rather in contrast to a vigorous interest in training and teaching.
General Practices were more likely to be contributing data to projects (for example to MRC Hypertension Trial of the late 1970’s) than initiating research.
This underdevelopment was apparent in the early efforts of the Fenland Research Club.
At that time it was thought highly innovative if GP’s collected any computerized data about patients and practices. It was even felt to be rather enterprising to have a card indexed age/sex register. Most of us were unfamiliar with basic research techniques: for example we had, perhaps for the first time, to think of the importance of sample size in a study. Our good intentions were not always matched by proficiency.
A study into surgery in elderly patients eventually foundered (after a good deal of fairly laborious data gathering) possibly because we had not defined an absolutely specific question. It’s perhaps notable that the meetings were held on weekday evenings after a full day’s work – we took that as unavoidable and ‘normal’ but it did mean that a degree of enthusiasm was required.Whatever its early misadventures the club developed strongly and contributed to a growing interest in GP-based research in Cambridge, which was paralleled by or connected with, for example, Juliet Draper’s and Sue Field’s research in the Early Parenthood Project.
Within a few years a much more efficient and organized approach to research, exemplified by Martin Roland’s work, appeared.
In such a setting I was stimulated to think about ‘appropriate referral’, which seemed to me to be a black hole. By present standards the guidelines we produced were over-simplified and outrageously unreferenced (what an age of innocence!) but they made a stab at clarifying the logical basis of a referral decisions relating to sixty common conditions in a range of specialties. 
 Fertig A, Roland M, King RH, Moore T. Understanding variations in rates of referral amongst general practitioners: are inappropriae referrals important and would guidelines help to reduce rates ? BMJ 1993;307:1467-1470.