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BACKGROUND General practitioners have described barriers to the uptake of incentives such as the Enhanced Primary Care items introduced to support care of chronic illness. However patients’ attitudes toward chronic illness and planned care are not known. METHODS A qualitative study of adult patients with chronic illnesses using semi-structured interviews and a focus group, examining their experience of chronic illness and their attitudes toward health care. RESULTS Sixteen patients were interviewed; five participated in the focus group. Patients believed that their illnesses were permanent and progressive, and that GPs had little influence over their prognosis. They preferred to access GPs for acute problems rather than anticipatory care, and most could not see a need for care planning. DISCUSSION Patient preferences for care delivery may be in conflict with the current reform agenda focussing on anticipatory care provision. Efforts to reform chronic illness care may falter unless this is addressed.