have free access to hospital specialists. Patients that are covered by the Sickness Fund require a referral care, and the privately insured must have a referral letter written by the general practitioner. GPs are real 'general' practitioners, because they are specialized in common and minor diseases and care for patients with chronic illnesses. The impact of the gatekeeping function is illustrated by the low referral rate to specialists: 90% of all complaints is treated by GPs. There is, therefore, a big difference between specialists and general practitioners. The specialists only treat a very select and limited segment of the total spectrum of morbidity. The last characteristic is family orientation. It reflects the fact that general practitioners in the Netherlands serve as personal physicians for the entire family, that is, all members of the family or household have the same GP. This family orientation is of importance, because family members share the same home, the same living circumstances, food and environmental conditions. Additionally, they also share a lot of important risk factors, they share hygiene and social level. GPs, therefore, are in a position to understand the essential link between disease and family factors. Every general practitioner has about 2300 patients, so it is not so hard to get to know the most of them. Almost half of the GPs does not work alone, but they work with other doctors or other health care workers, like nurses, social workers, physiotherapists, in partnerships or group practices, GPs make many home visits. They also have a lot of contact with the district nurses that visit a patient at home. Because of the essential functions of GPs, they are in most cases the pivot when a patient needs home care.
Screen 22 (family doctor/general practitioner: foto Jos Stairs + patient)
On this screen you see a general practitioner with a patient, In the computer on his desk he keeps records of all his patients. This doctor is also one of the doctors who take part in a computer network that connects GPs with my hospital. As a result this doctor receives the
