For the first many years the EGPRW was an ill-defined group of doctors, oddly unstructured, only kept together by a common interest and a mailing list. After a while National Representatives were appointed by those who happened to be present at that time, and they formed The European General Practice Research Workshop (EGPRN) grew out of an informal meeting held at Leusden in the Netherlands, where in October 1971, representatives from bodies engaged in academic and research activities associated with general practice met to develop international cooperation. Those interested in education went on to form the European Conference on the teaching of general practice, the European Academy of Teachers in General Practice (EURACT) and those whose interest was research initiated EGPRN. After a while National Representatives were appointed by those who happened to be present at that time, and they formed some sort of a Board. Meetings were organized by the Chairman in cooperation with GPs from different countries, interested in research, National Colleges (if they existed) and the Societas Internationalis Medicinae Generalis, with expenses being met by the participants themselves. The initial meetings involved countries in Northern Europe but this was rapidly extended to Southern European countries and recently, ones in the East. Since November 1974, regular biannual meetings have taken place: by May 2005, 60 meetings had taken place.
Initially, members met to exchange ideas and views about the research problems in general practice. The true nature of the general practitioner's essential role in health care was just evolving and being understood at least by general practitioners themselves. From the beginning, the Workshop was concerned with identifying these real problems and establishing the rules and criteria for systematic enquiry in this new field. All early participants would acknowledge that the Socratic framework of constructive creative debate among peers with similar problems was the essential first step to the painstaking process of establishing a truly scientific framework for an understanding of the problems peculiar to primary care. This process was underway throughout Europe but the workshop was a unique opportunity for the consistent consideration of basic primary care problems against an international background. There was an emphasis on descriptive techniques and on ways of living with the lack of agreed criteria, definitions and labels which could be applied consistently.
There was exploration of the way in which the "problem and action" basis for much effective general practice could be systematically explored with the limitations of traditional hypothesis testing techniques. These initial restraints led to feelings of frustration among some participants who felt that there was not enough traditional "real" research. The emphasis at meetings in the first 8 10 years was therefore on the evolution of problem solving techniques and method rather than the presentation of final results. Much of the time was spent in the systematic constructive criticism of research method almost always in the context of planned personal research studies from individual members. For example, Robin Hull, in a series of delicious and fragrantly intuitive cameos accurately transmitted the flavour of general practice as he explored it across Europe. These initial descriptive studies have been followed up by ever more rigorous and standardized studies of the Interface between Primary and Secondary Care which have involved the members of the Workshop as a whole. The European Study of Referrals from Primary to Secondary Care was based on standardized criteria, definitions and measurements of the referral process in each of the European countries and for the first time enabled a direct international comparison of the referral process in Europe. This is an example of the more general development of research activity stimulated within, and then conducted by the Workshop. Standardized criteria definitions and method are also necessary for any international comparison of the incidence and prevalence of morbidity. EGPRN also collaborated in the planning of European studies under the auspices of the EC (COMAC HSR).
A Weekly Return System for infectious and communicable diseases existed in Great Britain. A similar system was also in operation based on sentinel practices in Holland. Similar systems were then set up in Belgium and Denmark and followed by France. These earlier developments have now resulted in a centralized Eurosentinel Concerted Action on Sentinel Health Information Systems with General Practitioners funded by the EEC and managed by the Institute of Hygiene and Epidemiology in Brussels.
Over the years, much effort and thought has been given by the Workshop to what is called the denominator problem. Incidence and prevalence rates require accurate estimates of populations at risk. These are difficult to obtain in countries with health systems not involving patient registration. Important contributions have been made by the Workshop and its members though no final answer has yet been found to this problem.
Other international studies have been (and are being) carried out by smaller groups of GP researchers through the EGPRN network, e.g. the Home Visit Study, the International GP Burnout Study and the Eurobstacle Study (identifying obstacles to adherence for diabetic patients).
To summarise the evolution of the Workshop, one could say that initially the members were active general practitioners, intuitively aware of the necessary basis for (and restraints on) problem solving in primary care. In particular, the primacy of the direct "problem/action" mode over the logical diagnostic model of signs/symptoms diagnosis/management.
In parallel to this general improvement in understanding the limitations on clinical procedures in general practice and their impact on systematic scientific enquiry, went an increasing diffusion, understanding and new use of more appropriate statistical and other methods, including qualitative research methodologies. This was accompanied by an increasing awareness and understanding of how to handle the range of inter doctor variability within any country as well as the variability between countries.
Increasingly clinical and preventive general practice care must be underpinned by research evidence, creating evidence-based general practice as a relatively new paradigm. Research projects are assessing effects of diagnostic or therapeutic interventions, which remains extremely difficult in the fairly unstructured, low-risk environment of primary care. Discussions at EGPRN workshops are dealing more and more with the balance between demands of best evidence, patient choices in practice and the assessment of quality.
These trends have been accompanied by the appearance and now the explosive increase in the numbers of young, motivated colleagues in academic and active general practice who are taking over future developments. They do not only come from the North West of Europe but also Southern and Eastern Europe. With the inauguration in 1995 of the European Society of General Practice/Family Medicine (ESGP/FM - WONCA Region Europe), EGPRN has been recognized as the key network organization for research in general practice in Europe, and takes the main responsibility for this area of work within the ESGP/FM. At the Ankara meeting (May 2003), a new name 'EGPRN' was chosen instead of 'EGPRW' (European General Practice Research Workshop), to express the ambition to participate in building a European primary care research training network and to contribute to the scientific debate on general practice, family medicine and primary health care. EGPRN exists now as the forum for research in family medicine and aims to disseminate information about research among primary health care professionals throughout Europe. Several other decisions were taken in May 2003: a new timing within the meeting, the organisation of pre-conference workshops, parallel sessions, a clearer role of national representatives and the formal installation of subcommittees (see further). EGPRN also raised the quality and output of its meetings, without losing the typical EGPRN 'friendly atmosphere'.
EGPRN is an independent body but over the years has worked closely with other organizations, academic bodies and teaching departments of general practice throughout Europe. As a network for general practice research in Europe, EGPRN strengthens its position step by step, especially in collaboration with the ESGP/FM and by interaction with the other networks, EURACT and EQuiP. EGPRN keeps contact with other research networks, such as the International Federation of Primary Care Research Networks (IFPCRN) and the North America primary Care Research Group (NAPCRG), working on their common goal, building research capacity in family medicine.