Intended for healthcare professionals

Letters Covid-19 worldwide

Regional coordination and bottom-up response of general practitioners in Belgium and the Netherlands

BMJ 2020; 369 doi: (Published 03 April 2020) Cite this as: BMJ 2020;369:m1377
  1. Josefien van Olmen, tenure track professor,
  2. Roy Remmen, professor of general practice,
  3. Paul Van Royen, professor of general practice,
  4. Hilde Philips, professor of general practice,
  5. Veronique Verhoeven, professor of general practice,
  6. Sibyl Anthierens, professor
  1. Department of Primary Care, University of Antwerp, Doornstraat 331, 2610 Wilrijk, Belgium
  1. josefien.vanolmen{at}

General practitioners are at the core of the healthcare response to the emerging covid-19 epidemic in European health systems.1 The coordination of primary care differs across countries; we describe the response in Belgium and the Netherlands.

In the initial phase, central public health authorities developed a national protocol for screening and case finding. In the Netherlands, decentralised municipal public health services were appointed to support case finding for patients not needing acute care. Belgium does not have decentralised preventive health services to support at the operational level, so implementation of the protocol was left to healthcare workers. In both countries, out-of-hours services and GP groups were at the centre of local coordination to develop a first response for patients who needed acute care.

In the subsequent stage, both governments scaled up. The healthcare response took shape in organising diagnosis, care, and referral in coordination with hospitals and other services. The locus of coordination and the guidance for healthcare providers was different in each country. In the Netherlands, most approaches were centralised, with many regional triage centres as an adjunct to hospitals and regional coordination. In Belgium, first line triage posts and day practices became better organised. In the absence of regional coordination, the pattern seemed more scattered and varied. GPs committed to guaranteeing essential general care and avoiding collateral damage for other conditions.

The driver for these differences relates to the institutional context of healthcare systems, such as the level of decentralisation and the financing of healthcare providers. The presence of strong, professional GPs, in these and other countries, is the backbone of the health system response.


  • JvO and RR are GPs practising in the border area of Belgium and the Netherlands; PVR, HP, and VV are GPs in Belgium; SA is a sociologist.

  • Competing interests: None declared.

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