Need more GPs and coordination tools
- GPs can solve even more of the collaboration challenges in the health service. But they lack the necessary framework conditions and, not least, the digital systems that work together, says Marte Kvittum Tangen, head of the Norwegian Association for General Practice.
- GPs have a statutory medical coordination role for their list patients, and must collaborate with other relevant service providers on their own list residents, Tangen reminds us. Marte Kvittum Tangen heads the Norwegian Association for General Practice, and is herself a specialist in general practice. She clearly sees a greater focus on improving collaboration around the sickest patients, and she believes that the Norwegian GP scheme should be the foundation of any collaboration solution.
- This is something we are very concerned about. Many GPs have described the challenges associated with patients with complex needs well over the past year, but good collaboration around these patients is difficult to achieve. We have challenges related to digitalization, the new health communities and the coordination reform that underpins it all, she says.
She then refers to the acute shortage of GPs in Norway, and the challenge of recruiting emergency doctors to a rotation schedule - which in many municipalities is difficult to combine with family life.
Solve the GP crisis first
- We have a GP crisis in Norway. We need to develop a better framework for the GP scheme so that it can become what it should be. To solve this, we need more GPs, and individual GPs need to have fewer patients on their lists, Tangen points out.
She is convinced that Norway can cut major costs in the specialist health service by putting more resources into the primary health service.
- 9 out of 10 problems are dealt with in primary care, and having a stable GP over the years prevents health problems, says Tangen, referring to the continuity study published last year by GP Hogne Sandvik and co-authors. The study documents that patients who have had the same GP for more than 15 years are 28 percent less likely to be hospitalized, compared to patients who have had the same GP for one year or less. Knowing their GP well also resulted in better survival rates overall.
The best place to start
- My starting point is that Norway has the very best organization of general practitioner services for patients. Many other countries would like to have a GP scheme like ours, and for the patient it is a great advantage that there is a regular doctor who has the overall coordinating responsibility. The service is not improved by fragmenting the coordination or using private health services, says Tangen.
Marte Kvittum Tangen finds the goal that Dignity Care is working towards, to find out what a digital collaborative tool must contain, interesting.
- It sounds really exciting! We need digital tools to interact better. We don't need the same system, but that different systems talk to each other and make it easy for the user to retrieve the right information when they need it. We also need to rethink the methods we currently use for collaboration. For example, it should be easier to have a specialist on a screen in the GP's office. It's becoming old-fashioned to communicate by sending patients back and forth between hospital and GP with referrals and discharge summaries. We already have tools to simplify things, allowing the patient to avoid certain stages of the treatment chain. The goal must be to use our health resources where they are most useful," Tangen points out.
50 percent chronic care follow-up
- At the same time, I think we have an incredibly good starting point in Norway if we ensure that the GP scheme works as it should. We know that this results in fewer hospital admissions. We see a clear correlation between GP coverage and the use of emergency care, that the use of emergency care increases where GP coverage is poorest.
Tangen points out that Norway has been named the world's best health service and is the country that spends the least resources on the health service in relation to what it manages to achieve. She has no doubt that the GP will be the best starting point for good collaboration, especially when it comes to patients with one or more chronic diseases.
- 50 percent of the consultations in a GP's day-to-day work involve the follow-up of chronic diseases, and most people who have a chronic disease have more than one. Roughly speaking, a GP spends a quarter of their time on other inquiries and the remaining quarter on acute inquiries.