I’ve just spent two days at the European Forum for Primary Care conference in Barcelona, and presented a poster, a paper and a video. Partly I go out of insatiable curiosity: what are people doing, what might we learn? Partly out of a sense of community, joining with others addressing the issues of primary care. 250 delegates from 33 countries have plenty to talk about. Movers and shakers – do join.
Human bodies have a lot in common all over the world, but while clinically much is similar there are very significant differences in the way primary care is organised.
From all the presentations heard and conversations enjoyed, a striking theme emerges: where others see systemic problems, the NHS system works. Where change is afoot, everyone is struggling to be more like the NHS. A few examples:
Spain – plenty of doctor graduates but a crash in the number choosing general practice. Fee for service model pays only 6 Euros per visit. And twice our use of prescriptions.
Germany – no registered lists. They know rural GPs are working 15% harder than those in cities, but they don’t know why
Austria – all single handers, no primary care teams, no gatekeeping role to specialists. Trying to change all this – but could take a generation.
Latvia – with just 3% of GDP spent on health by govt, self pay creates huge inequalities
Lithuania – a fight between GPs and paediatricians over who gets first contact with kids
Greece – no EHR (electronic health record) so inefficient, little idea of disease burden, no chance of sharing data
Turkey – since 2010 has followed NHS with free access, registered lists – but how do you like 3600 list per GP and 61 face to face contacts/day?
Quebec – trying to persuade GPs to register the population but 25% on central waiting lists. Access? More than two weeks, or less than 2 weeks.
The Netherlands seems to have addressed most of these issues in a similar way to UK, though funding is insured rather than general taxation. They have about 2200 per GP list, working in teams which also cover out of hours and have full access to EHR at all times. Access is good, same or next day. Bureaucratic burden seems lighter too. But they have a looming GP workforce crisis.
So what do other nations crave, which we take for granted?
- Universal and free at the point of use, funded by general taxation
- Fully capitated, no fee for service, no co-payment
- Registered list, GPs responsible through long term local contracts
- Continuity, care of the whole person & whole family, not disease or age specific.
- Gatekeeping role for GPs, economically efficient with under 5% referred.
- Complete EHR coverage (though underused)
- High status for GPs, parity with specialists.
- Recruitment issues yes, cataclysm no.
Britons, count your blessings, and thank the founding fathers of the NHS for getting a lot of it right. This is no call for complacency, but will you all stop bellyaching and get on with making a good system better.