Education And Debate

Medicine in Europe: The changing scene in general practice in Europe

BMJ 1994; 308 doi: (Published 05 March 1994) Cite this as: BMJ 1994;308:645
  1. P R Evans
  1. The Guildhall Surgery, Bury St Edmunds IP33 1ET.

    Europe is currently in a state of flux, not just in political and economic terms, but also with regard to medicine. Changes in the provision of medical care have been common throughout both western and eastern Europe.1 The changes have two main determinants: the need to match limited resources to increasing health care demands, and - especially in central and eastern Europe - the search for new health care philosophies allied to new methods of financing and delivery.

    Within this process of change, primary medical care is of increasing importance. In many countries hospital based care has traditionally been overvalued and emphasised to the neglect of the appropriate funding and development of primary care. This has led to the inefficient use of both primary and secondary care sectors, often with a lack of proper cooperation and integration. Growing value is placed on the role of the well educated and trained generalist at the primary level. This is clear from developments in the United Kingdom, Holland, Denmark, Sweden, Finland, Spain, and Portugal. From the countries of central and eastern Europe, in which Soviet-style health systems have increasingly failed to meet patients' needs, come numerous requests for information, literature, and expertise on topics such as the principles of primary health care, the role of the family physician, education and training of general practitioners, and the development of the discipline of general practice in both academic and medicopolitical terms.

    Diversity in general practice

    General practice throughout Europe is diverse in its development, organisation, and funding. Some aspects of this diversity can be seen clearly from table I, which shows the numbers of doctors in European countries and the percentage of general practitioners. Table II indicates the considerable variety in consulting patterns by general practitioners throughout the European Union. In spite of this considerable diversity, which has …

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