Some Japanese medical schools already provide courses of social medicine or public health and the development of a department of specialist primary care would complement these. These new departments could undertake research in primary care, support development of clinical guidelines specific to primary care, as well as teach the speciality at both under-graduate and post-graduate level. In relation to other OECD primary care systems, Japan is starting from an unusually strong position in one respect, in that the fee schedule already directs additional resources for treatment of patients with multiple chronic conditions, continuity of prescribed drugs and management plans and establishment of continuous care which offers on-call services with medical advice.