Study examines impact of losing a regular GP on patient outcomes and healthcare use

Introduction

In a groundbreaking study published recently, researchers have delved into the impact of losing a regular General Practitioner (GP) on patient outcomes and healthcare use. This research comes at a crucial time, as many countries, including Norway, grapple with the challenges of maintaining continuity in healthcare due to the rising shortage of GPs. In this article, we will explore how Norway's Regular GP Scheme, introduced in 2001, has significantly improved the quality of general medical services and ensured that residents have access to their own GP.

The Norwegian Regular GP Scheme

The Regular GP Scheme, a pioneering initiative in Norway, aimed to enhance the quality of general medical services by granting residents the right to register with their own GP. This scheme, which began in 2001, revolutionized primary healthcare by providing residents with the security of having a regular doctor who could manage their overall health needs.

Key Features of the Scheme:

• Right to Register: Any resident in a Norwegian municipality has the right to be registered with an RGP. This includes asylum seekers and their families who are members of the Norwegian National Insurance Scheme.
• Choice of GP: Residents can request registration with an RGP of their choice, provided there is free capacity on the doctor’s list.
• Responsibility of Local Authorities: The local authorities are responsible for organizing the RGP Scheme, including entering into contracts with doctors. Municipalities may work together on this task.
• Terms of Regular GP Contracts: GPs must agree to certain terms, such as a fixed maximum list size (1,500 patients for full-time practices), performing public general medical duties, participating in out-of-hours services, and supervising newly qualified doctors.

The Impact of Losing a Regular GP

The recent study on the impact of losing a regular GP highlights several significant findings. Researchers examined the consequences of GPs retiring or relocating between 2011 and 2021, focusing on the effects on healthcare use and mortality. The study involved almost 1.2 million patients associated with these doctors and compared their outcomes to those of patients who continued with the same GP.

Key Findings:

• Increased Healthcare Use: For every 1,000 patients who lost their regular GP, there were 13 to 16 additional contacts with the out-of-hours medical service and hospital emergency departments in the first year. Over five years, there were approximately 148 more contacts per year in general practice and 51 additional planned contacts in hospitals each year.
• Mortality Rates: The study found no difference in mortality rates between patients whose GP relocated or retired and those who had not.
• Continuity and Health Outcomes: The study suggests that long-term doctor-patient relationships are beneficial for health. Patients who had the same GP for more than fifteen years had a 25 per cent lower risk of dying compared to those who had the same GP for one year or less.

Challenges Faced by the Norwegian Healthcare System

Despite the success of the Regular GP Scheme, Norway's healthcare system is currently facing several challenges. One of the most pressing issues is the shortage of GPs. As of July 2024, just over 188,000 people in Norway do not have a regular GP, representing almost 3.5 per cent of the country’s population.

Factors Contributing to the Shortage:

• Workload and Responsibilities: Today's GPs are on average younger, more often employed on fixed salary agreements, and have fewer patients on their lists compared to 10 years ago. However, many GPs still face increased workloads, particularly outside normal working hours. The proportion of GPs working at least one day outside normal working hours has increased significantly since 2010, with a notable rise after 2018.
• Recruitment and Turnover: Recruitment to and resignation from the GP scheme occur more frequently in less central and populated municipalities. This results in shorter career lengths for GPs in these areas.
• Education and Training: The Norwegian Medical Association emphasizes the importance of dimensioning education according to future needs. However, many medical students receive little training in general practice, which contributes to the shortage of qualified GPs.

Solutions to Address the Shortage

In light of these challenges, several solutions are being proposed to address the shortage of GPs and maintain continuity in healthcare.

Proposed Solutions:

• Flexible Salary Systems: Salary systems should be more flexible and context-sensitive to attract more doctors to general practice.
• Reducing Patient Lists: The number of patients on a GP’s list should be reduced to alleviate the workload and improve working conditions.
• Decentralized Training: More decentralized training solutions, utilizing the capacity of smaller hospitals and rural physicians, could help increase the domestic number of medical students trained in general practice. This approach has been successful in countries like Canada and Australia.

Conclusion

The Norwegian Regular GP Scheme has been a remarkable success in ensuring continuity in healthcare. By giving residents the right to choose their own GP, the scheme has facilitated long-term doctor-patient relationships, which are associated with better health outcomes.

However, the current shortage of GPs poses a significant challenge. Addressing this issue requires a multifaceted approach, including flexible salary systems, reduced patient lists, and more decentralized training solutions. By implementing these measures, Norway can continue to provide high-quality primary healthcare services that prioritize patient continuity and satisfaction.

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References:

• Regulation relating to a Municipal Regular GP Scheme. (n.d.). Retrieved from https://www.regjeringen.no/en/dokumenter/regulation-relating-to-a-municipal-regul/id420530/
• What happens to patients when their GP retires or relocates? (2024, September 10). Retrieved from https://norwegianscitechnews.com/2024/09/what-happens-to-patients-when-their-gp-retires-or-relocates/
• The Norwegian Regular General Practitioner Scheme. (n.d.). Retrieved from https://www.researchgate.net/publication/283383030_The_Norwegian_Regular_General_Practitioner_Scheme
• Ongoing recruitment crisis In Norwegian general practice. (2018, April 25). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066296/
• Development in general practitioners' workload and situation over time. (2023, April 18). Retrieved from https://www.fhi.no/en/publ/2023/Development-in-general-practitioners-workload-and-situation-over-time/