In this publication the author states:- A new approach is needed for agenda-setting in primary health care. It should draw on the public health and participatory model espoused by W.H.O.; build on the experiences of local projects and initiatives, and seek to create planning and management structures which achieve change at both district and local levels. This document reviews current approaches in four key areas of primary health care:- raising standards; monitoring quality; user involvement; planning and management of primary health care services. Possible issues for a new agenda are suggested.