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BACKGROUND : In 1993 a list patient system was introduced in four Norwegian municipalities: Trondheim, Tromsø, Lillehammer and Asnes. MATERIAL AND METHODS : Questionnaire surveys were conducted among all GPs in these four municipalities in 1996 and 1999 for the purpose of examining changes in their assessment of the list patient system. RESULTS : The number of GPs generally satisfied with the list patient system declined over the three-year period. Doctors found their workload heavier in 1999 than in 1996, but their confidence in the list patient system as a tool for enhancing quality in general practice did not change over the period. GPs with too long patient lists were the most dissatisfied. The decline in confidence in the new system was strongest in Trondheim, the largest of the four municipalities and that in which the average patient list is longest. In Tromsø, the second largest municipality, with moderate to average patient lists, there were no changes in GP attitudes. INTERPRETATION : The study demonstrates some important consequences of a shortage of medical manpower in a list patient system. Local authorities will have to deal with these challenges.

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