FAMILY MEDICINE IN SCANDINAVIA

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The lack of GPs in Sweden, Norway and Denmark means an increase in the need for doctors from other European countries. For this reason, many hospitals have been turning to foreign recruitment.

Working as a GP in Sweden

At general medicine clinics, there is usually equipment for minor surgery and various types of examinations, which are carried out in hospitals or specialist clinics in many other countries.

Primary care centres in Sweden are modern and well equipped. Usually, the team of a primary care centre has approximately 20-40 employees, including about four to six family doctors, nurses, physiotherapists, laboratory staff and assistants. Private practices with only one GP exist but are rare.

Primary care represents around 20% of the total healthcare budget. Since 2010, patients can register with any public or private provider accredited by the local county council and registration based on the latest visit or shortest geographical distance. This is the case in most county councils for individuals who do not have an active choice of providers. Irrespective of registration, however, primary care has no formal gate-keeping role in most county councils, and patients are free to contact specialists directly. Accessibility is emphasised in the primary care system. Home-nursing service is in most cases not run by county councils but by the local municipal authority.

Working as a GP in Norway

GPs most commonly work in group practices of three to eight GPs. Another important part in primary care is home-nursing service. Furthermore, inhabitants have access to occupational therapists and physiotherapists. All these services are delivered by municipalities; however, a majority of physiotherapists deliver care as private enterprises.

In 2001, a registered patient list system was introduced, implying that all citizens are assigned to a general practitioner (GP) of their choice. Over the 11 years this system has been in place, it has become very popular among patients as well as GPs. It secures continuity of the doctor-patient relationship and facilitates appropriate use of healthcare services.

Working as a GP in Denmark

General practice is the cornerstone of Danish primary healthcare. Practice units are fairly small: Close to two GPs per unit plus nurses and secretaries. The units are fully computerised, that is, with computer-based patient records and submission of prescriptions digitally to pharmacies, etc. Over the past few years, a decrease in solo practices has occurred and is expected to accelerate, in part because of the GP age structure, with many GPs retiring and new GPs not wanting to practice alone. This latter workforce trend is pointing toward a new model with employed GPs, particularly in rural areas.

On average, all Danes have 6.9 contacts per year with their GP (in-person, telephone, or e-mail consultation). General practice is characterised by five key components:

  • A list system, with an average of close to 1600 persons on the list of a typical GP
  • The GP as gatekeeper and first-line provider, as a referral from a GP is required for most office-based specialists and always for in- and outpatient hospital treatment
  • An after-hours system staffed by GPs on a rota basis
  • A mixed capitation and fee-for-service system
  • GPs are self-employed, working on contract for the public funder based on a national agreement that details not only services and reimbursement but also opening hours and required postgraduate education. General practice is embedded in a universal tax-funded healthcare system in which GPs and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new challenges