A number of doctors from the action group Very Worried Doctors are concerned about the future of our healthcare in an opinion piece: they write that the “collapse of our healthcare” is near. Such a signal deserves attention: what are the arguments that lead to this far-reaching conclusion and what can we do to strengthen healthcare?
First concern: GPs can no longer guarantee the quality of care due to too many patients. There is currently approximately one full-time equivalent (FTE) general practitioner per 1,000 to 1,200 inhabitants. In other comparable countries there is one FTE for 1,500-1,700 inhabitants. The care for patients is increasing, but general practitioners can cope with this through better organization. Support staff for reception and secretariat (and in the future also practice assistants specifically trained for general practice), as well as more and more nurses, who play a role in prevention, the follow-up of chronically ill, etc. make the work of the general practitioner more feasible. Division of tasks and collaboration improve the capacity and self-care of general practitioners. This allows the general practitioner to concentrate on the core tasks: diagnosis of health problems at an early stage, health promotion, empathetic guidance, drawing up care planning together with the patient, providing scientifically substantiated answers to questions from worried patients.
Fluff or not fluff
The GP is also in an excellent position to quickly determine whether it is ‘all right’ or ‘not all right’ and, if necessary, to refer the patient to the emergency room. General practitioners are trained to make this distinction. This means that, except in exceptional situations (suspicion of a heart attack, an acute problem with blood circulation in the brain, a serious accident or a major bleeding cut, etc.), the patient will only be admitted to the emergency room with a referral letter from the GP, which means that it becomes quieter there and people can concentrate better on serious problems. In this way, the second concern, the ‘improper’ use of emergency admission, is also addressed.
One of the concerns of the action group is that patients visit their GP too often. Indeed, if a patient only goes to the doctor for a certificate of ‘incapacity for work’, while he/she knows exactly what to do with his/her complaints, then that is not a useful consultation. In the meantime, such a certificate is no longer necessary for one day of incapacity for work and this can safely be extended to three days. This approach also requires a commitment to targeted health education for the population, so that everyone has more opportunities to tackle some of the health problems themselves.
The waiting lists at a number of specialists indeed hinder access to specialist care for patients who really need it. Going to the dermatologist (skin doctor) for a wart, to the gynecologist for cervical cancer screening, to the ophthalmologist to adjust the glasses… that is not a good use of the specialized competence of these doctors.
The action group indicates that the fact that the financial accessibility of general practice (third-party payer arrangement and a limited personal contribution) is a reason why many people visit their GP. There is little scientific support for this. People do not sit in the doctor’s waiting room for pleasure. Moreover, there are many examples in our own country and abroad where patients consult their GP without having to pay, and yet there is no higher number of consultations per patient (a lower number in the Netherlands, for example). Reducing financial accessibility is not an option: lowering barriers brings vulnerable patients into care.
Sustainable care
What could we do to improve the current organization of healthcare?
Why wouldn’t general practices that are close to each other form a ‘primary care network’ together, where they agree to collaborate more in healthcare provision, including nurses, physiotherapists, primary psychologists, social workers, etc. involve? In this way, healthcare becomes more sustainable. Then the ‘patient stops’ that only increase the pressure on practices can be phased out: after all, patients will be able to find a GP in the ‘primary care network’ in a transparent manner. If these primary care networks provide care to at least 10,000 patients in urban areas and at least 5,000 in rural areas, the carrying capacity of general practices will increase, without placing a greater burden on individual general practitioners.
We realize that general practitioners in some regions have a more difficult time than in others. Even with primary care networks, not everything has been solved in the Westhoek or Vilvoorde region and in Brussels. Additional efforts will be needed here.
For this to be successful, patients will also have to adjust their use of healthcare. By showing solidarity with other people in need and using the health care system in a sustainable manner, they can contribute to strengthening the health system.
The government can help achieve this with scientifically substantiated measures. Our healthcare system will become stronger and not collapse if we continue to deploy the necessary resources in solidarity.
){kind=link}