This document discusses the future of entrepreneurship in primary care in the Netherlands. It addresses demands from both a public and professional perspective. There is increasing pressure on the current primary care system, and entrepreneurship may provide a better solution than a national integrated care model. However, current entrepreneurship is mainly cost-driven and not focused on innovation or multidisciplinary care. Opening primary care to outside entrepreneurs could help with culture, scale, and capital, but regulations would be needed to protect professional autonomy and public access. Health insurers and retailers may be the best partners, while hospitals and pharmaceutical companies should be excluded from entrepreneurial roles in primary care.

1. Drs. SPM (Steven) de WaalThe future of (professional) entrepreneurship in primary care

2. Public SPACE Research in Primary CarePublic SPACE, Center on Strategies for Public And Civic Entrepreneurship is a private, independent Think Tank, aimed at the development of ‘Winning Strategies for the Common Good’, from the perspective of civil society.This project is in cooperation with the Dutch National Association of Small and Medium sized Employers and ABN AMRO BankMain focus on general practitioners, dentists, pharmacists and physiotherapistsIs there a future for (small) professional entrepreneurship in primary care? Under what conditions and what will be the public effect on primary care?

3. How to cope with big institutions like health insurers and hospitals?

4. What must be the effect on government policy?Demands from a public perspectiveGeneral:- Accessibility (geographical, acute care, outside working hours, information) - Affordability- Quality Cost control (direct and indirect)Specific: Prevention

5. Substitution

6. Appropriate care

7. Complex care/cure

8. ICT in information (EPD) and care (domotics)INCREASING PRESSURE; CURRENT ORGANIZATION NOT UP TO IT

9. Demands from a professional perspective Autonomy in practice

10. Limited competition

11. Enough market demand

12. Long term income (challenged: claw back; (very) low tariffs)

13. Choice to work on the payroll