Intended for healthcare professionals

Letters Buurtzorg: Dutch district nurses

Buurtzorg could work in the UK, but why must it fit into the existing system?

BMJ 2017; 359 doi: (Published 24 November 2017) Cite this as: BMJ 2017;359:j5376
  1. Michael Bowen, consultant gynaecologist
  1. Oxford, UK
  1. mikebowen{at}

The piece about the Buurtzorg concept of social and nursing care in the community almost had me misty eyed with hope for the future.1 Few challenges are more important and pressing than resolving this matter in the UK. And we must resolve it or the logistic and financial effects will bulldoze every other health agenda out of the way.

The Dutch approach has almost re-invented the concept of mission command. This strategy, pioneered by the Prussians, combined centralised intent with decentralised implementation. It promoted freedom, speed of action, and initiative, within defined constraints.

The concept was crystallised by Moltke in the 19th century: “A favourable situation will never be exploited if commanders wait for orders. The highest commander and the youngest soldier must be conscious of the fact that omission and inactivity are worse than resorting to the wrong expedient.”2

The key tenets of mission command are building cohesive teams through mutual trust; creating shared understanding; providing a clear commander’s intent; exercising disciplined initiative; using mission orders; and accepting prudent risk.

There can be no greater accolade for De Blok and colleagues, who have achieved so much with Buurtzorg, than to have a number of nations try to copy them.

Sadly cynicism crept in when I read the statement, “Buurtzorg will need to fit into the UK system.” No doubt the person who said this is still trying to ram their DVDs into a Betamax VCR, hoping they will work despite not doing so for the past 20 years. This single statement encapsulates all that is wrong with the NHS, because the notion that the UK system may need to fit in with Buurtzorg is not considered. It would be a bold paradigm shift but may also make some of the expensive parasitic hierarchy extinct.


  • Competing interests: None declared.


View Abstract