Genetic counselling and testing in Europe.

The Genetic Enquiry Centre in Manchester has designed a three-pronged health services research programme to address current issues in genetics. The issues are: whether doctors who are not trained in genetics can manage the genetic problems they meet in their practice; whether there are enough resources in specialist centres to cope with current and imminent referrals; and whether providers of primary care recognise genetic problems and refer patients appropriately. The three studies providing the basis of the programme--the National Confidential Enquiry into Counselling for Genetic Disorders, the Concerted Action on Genetics Services in Europe and the Primary Care for Genetics Patients study--are discussed. The first two provide unique views of genetic counselling in the UK and of the access to and quality of health services for patients with or at risk of genetic disorders throughout Europe, and make recommendations based on their findings. The third is a continuing study that aims to determine the effects of patterns of referral and care in the different healthcare systems in Europe. Although it is unlikely that there will ever be enough medical geneticists to cope with the consequences of genetic advances on health services that are largely unprepared, specialist genetic centres are the natural core resource for future multi-specialty genetic services. This will give clinical geneticists an extended role complementary to that of diagnosing rare syndromes.