Western health care systems are facing today increasing movement of genetic knowledge from research labs into clinical practice. This paper reports the results of a survey that addressed the confidence of primary care physicians in their ability to carry out basic medical genetic tasks. The survey was conducted in five countries (France, Germany, The Netherlands, Sweden and the UK). Stratified random samples were drawn from primary care physicians in the five countries representing a sampling frame of 139,579 physicians. Stepwise binary logistic regression procedures were performed to identify the predictor variables for self-reported confidence. Three thousand six hundred eighty-six physicians participated and filled out a self-administered questionnaire. The margin of error for accurate representation of each group of European general practitioners and specialists in the total sample is 2.9% for GP, 2.8% for obstetricians/gynaecologists (OB/GYN) and for paediatricians (PAED) 2.6% (95% confidence level). Confidence in their ability to carry out basic medical genetic tasks is low among participating primary care physicians: 44.2% are not confident, 36.5% somewhat confident, confident or very confident are 19.3%. In each country, those confident/very confident represent less than 33% of the participating physicians. Primary care physicians who report the lowest levels of confidence prove to be those least exposed to medical genetics information and training. Although there are significant differences in the way in which professional education is organised and practice is regulated across European countries, there is a need for a coordinated European effort to improve primary care physicians' background in medical genetics.

Further national and international research is needed to understand better the causal variables underpinning differential attrition rates, with particular regard to understanding how different groups may experience the relationship between education and their broader circumstances and between the theoretical and the clinical elements of nurse education itself.

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Objective: To investigate the feasibility of improving screening for carriers of haemoglobin disorders in general practice by using a nurse facilitator to work with primary care teams and the relevant haematology laboratories; to identify problems in communication between all those involved in delivering the service, and to implement solutions. Design: Two year, practice based randomised controlled trial. Setting: North London area where 29% of residents and 43% of births are in ethnic groups at risk for haemoglobin disorders. Subjects: 26 of the 93 practices using the services of the area's haematology laboratory agreed to take part and were randomly divided into control and intervention practices. Main outcome measure: Change in number of requests for screening tests for haemoglobin disorders made by control and intervention practices in baseline and intervention years. Results: The number of screening tests requested varied from 0-150 in the 93 practices in the baseline year. Study practices tended to have made a moderate number of requests (10-50) during this period. During the intervention year intervention practices made 292 more requests (99% increase) and control practices made 74 fewer requests (23% decrease; P = 0.001 for difference in median change). Four practices, three of which were singlehanded, accounted for 75% of the increase. The number of requests from intervention practices, adjusted for baseline requests, was 3.2 times higher than control practices (P < 0.0001). Conclusion: General practitioners and practice nurses are willing to undertake a new genetic screening service (or expand an existing one) if they are persuaded that it benefits the health of a significant proportion of their practice population. They need appropriate tools (for example, information materials for carriers and groups at risk), and the laboratory must be sensitive to their needs. Preconceptional carrier screening and counselling need to be coupled with antenatal screening.Screening for carriers of thalassaemias and sickle cell disorders (haemoglobin disorders) is established in the United Kingdom, 1 where over 6% of residents and 10% of newborns are of Asian, black, Mediterranean, or mixed parentage.2 On average, 8% (range 3-15%) of these groups are healthy carriers who can be readily identified by screening for haemoglobinopathy.3 Carrier couples have a 25% risk in each pregnancy that the child will have a serious haemoglobin disorder, and timely information allows them informed choice among reproductive options, including prenatal diagnosis.Though the laboratory diagnosis of carriers is relatively simple, screening a population involves many steps and different services.1 Premarital screening is routine in Cyprus 4 and screening is offered in high schools in Montreal. 5 In Britain most district health authorities have opted for routine antenatal screening. Since maternal blood is often first taken at around 16 weeks of pregnancy, many carrier couples are offered prenatal diagnosis in the second trimester. 6 ...

The Gen-EP scale could be a helpful instrument in different countries to organize and evaluate the impact of genetic educational programs for primary care providers.