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['European primary care': a visionary report of the Dutch Health Council on primary health care in the European Union].

Although the agenda of the European Union (EU) does not directly provide for it, it seems reasonable to assume that due to the process of European social and economic integration there will be mounting pressure on the presently widely differing systems for primary care to move towards a more uniform orientation. In 2004, during its rotating presidency of the EU, the Dutch government asked its Health Council for advice on the current level of knowledge with regard to the organisation and significance of primary care. The Council formulated a set of key recommendations for the future development of primary care in Europe. The Council defines primary care as: generalist care, consisting of general medical, paramedical and pharmaceutical care, nursing and supportive care and non-specialised mental and social health care together with preventive and health educational activities linked to these forms of care. This care is for all health problems, is aimed at ambulatory patients, and is delivered close to the patients' homes. It is easily accessible to all, and provides emergency care when necessary. The main differences in the provision of primary care between countries in Europe concern the presence or absence of registration with a general practitioner and the gate-keeper role of primary care. International comparative research has identified the presence of precisely these features as predictors of better health outcomes in terms of morbidity and mortality. They therefore form a prominent role in the key recommendations, which state, among other things, that a patient should choose a primary-care team in the context of an integrated care circuit, thereby giving up his or her freedom to select care givers outside that circuit, in the interest of quality continuity and the efficiency of care. Other key recommendations are: close cooperation between primary-care teams, preventive services and public health and occupational health, a transparent provision on information between all providers of care, and the creation of a European Center for primary-care development.