During recent years, Europe has witnessed a discussion about a new definition of general practice. At the regional WONCA conference in London, 2002 WONCA Europe launched a European definition of general practice.^1,2 The ambition is that this definition and the 48-page paper explaining the definition should encourage a debate among all colleges in Europe and around the world. The discussion was initiated by a paper in the BMJ co-authored by Professor Jim Dickinson from the Chinese University of Hong Kong.³

We claim that general practice is a speciality in itself. This means that our performance should add value to the overall performance of the health care system. It also means that we should have an idea about the core elements of the discipline, and that this idea should manifest itself in research, teaching and quality assessment.

Do we need a new definition of general practice at all? No, we do not need a new definition for definition's sake, but a definition is a good starting point for a discussion of the core content of the discipline. From this core content the agendas for research, education, teaching, training and quality assurance can be derived so as to establish a direct link between the elements. Teaching and training should be based on theory and research as well as on daily clinical practice. It is an essential dimension in the European definition that a GP should take a bio-psycho-social approach, i.e. a complex, intuitive decision-making approach, reflecting that he/she simultaneously considers and diagnoses any disease in the three dimensions described in the bio-psycho-social model.

In other words, general practice is a discipline focusing on the biological parts of medicine and at the same time considering the context in which symptoms and diseases are expressed and experienced. This means that the GP should take a balanced, scientific approach to all three dimensions. Most of us are able to demonstrate a good scientific approach to the biomedical dimension, but we should ask ourselves whether enough research is being done in the psychological and social dimensions? Do we, for example, know enough about network theory, about the interaction between a person and his/her network, about the cultural influence on disease, about ways of keeping people healthy (salutogenesis)? Do we, for example, know enough about empowerment, coping, health perception and somatising behaviour?

Another essential part of the European definition is that we recognise ourselves as part of a total health care system, participating in the administration of the available resources. Is it time for the GPs to pay more attention to clinical decision making processes and to focus more on health services research, i.e. research in the overall functioning of the health care system, and on research including health economy, task distribution between different parts of the health care system and a team oriented approach to providing health care?

The concept of continuity of care was also a central part of the discussion prior to the suggestion of the final definition.^4,5 The final definition maintained continuity as part of the definition. This may create some problems in the future as it is a fact that not all GPs can maintain continuity, e.g. if they work as locums or if they work in an ambulatory care setting. Is continuity as important as we have stated? Yes, continuity is important to any human being, especially in relation to health, but is there any particular reason why we as GPs should make continuity into something special in our discipline? Should we rather focus on the benefits which are more easily obtained by working in a health care system with continuity of care?

The real effect of continuity is that it makes it easier for us to make a multidimensional bio-medical, cultural, psycho-social diagnosis. Continuity enables us to establish the crucial therapeutical relationship with our patients that helps us perform the complex diagnostic and therapeutic decision process characteristic of general practice. This relationship allows us to have a strong impact on patients' health perceptions and their decisions about health care. Thus, continuity is a tool to obtain the relationship, but it may also be obtained by using other tools, including the tools of trust and good communication skills.

Should we in the future focus more on the qualities underlying the concept of continuity, namely the skills at making a multidimensional diagnosis and giving treatment in a good patient-centred dialogue?

Any doctor, not just GPs, should have good communication skills. It is a crucial tool for all doctors. Perhaps GPs, who are so dependent on good communication skills, should do the teaching, but it is not because of our communication skills that we can claim to add value to a health care system. Any doctor should aim to obtain good communication skills and thus contribute his or her small share of added value to health care.

Has general practice talked too much about communication and continuity as aims in themselves? They are tools enabling us to attain the core value of general practice, namely the interpersonal empathy that establishes the diagnostic and therapeutic relationship with our patients.

Should we also tell students and young doctors, decision makers and politicians more about our awareness of our position as front line workers in an area with low prevalence of disease and subsequent low predictive values of any symptoms? Small changes in clinical decision making in the front line have far-reaching consequences for the workload in the secondary health care system.

The real challenge the new definition poses is to arouse a discussion about the core contents and to implement comprehensive research programmes reflecting all the core competencies where general practice add value to a health care system.

Another challenge is also to establish a logical coherence between research, teaching and training in basic, vocational and continuing medical education.

If the European efforts to formulate a new definition could lead to a new ideologic discussion in general practice, it might make us better at explaining and teaching where general practice adds value to a health care system.