2024-02-05 16:31:01
‘The GP is drowning!’ it sounds about as often as ‘The GP shouldn’t complain so much!’. Because yes, we as healthcare providers are all busy. Nevertheless, understanding the position of general practitioners that has arisen is important and empathy, thinking along and sometimes also helping from colleagues in primary, secondary and tertiary care is desperately needed. Precisely to prevent the ‘care train’ from derailing in the Netherlands.
In a recent interview in the Volkskrant, general practitioner Hans Peter Jung says that in 1995 he still handled five thousand consultations per year; fifteen years later there are fifteen thousand, without any more patients. The causes of this tripling are social developments such as an aging population, secularization and a sustainable society. But also substitution of care, shortages elsewhere in healthcare and an unhealthy lifestyle.
“Practices have grown into mini-hospitals”
As early as 2005, it was predicted that 50 percent of current healthcare needs would be lifestyle-related. We believe that this percentage is now higher. The decreased number of smokers is generously compensated by the use of e-cigarettes and vaping. And the current older generation smoked the most in the past. We know from research that 80 percent of smokers die from a smoking-related disease.
Furthermore, we have started drinking at least 66 percent more alcohol in the past ten years. This results in an increase in diseases, such as various types of cancer, liver cirrhosis, but also Korsakoff’s and dementia. In addition, we exercise less and gain weight. Obesity alone is responsible for more than two hundred lifestyle-related diseases, including osteoarthritis, diabetes, dementia, but also abdominal wall hernias and colon and breast cancer.
All this causes an enormous burden of disease for the patient and demand for care for the GP. Because that is usually the place where these conditions come to light and treatment takes place or is coordinated.
In addition to the exponentially growing flow of care questions about lifestyle-related conditions, there are concerns about the limits to substitution of care. For example, care for the elderly, patients with cardiovascular disease, type 2 diabetes, COPD, mental disorders and abortion care have already moved from hospitals to primary care. There is currently even discussion about moving oncological aftercare to general practice.
‘Just because a GP can do a job does not mean he can be involved’
Practices have grown into mini-hospitals with practice assistants in somatics/pulmonary diseases/youth/mental health care/elderly care, physician assistants and general practitioners. And yet three quarters of general practices struggle with insufficient or insufficient space, according to research by the National General Practitioners Association. They are growing out of their joints, which are often poorly maintained. Placing portacabins in the parking lot for additional workplaces. And we are forced to impose registration stops. Due to a lack of waiting room and consultation room space, but also due to a lack of staff. For general practitioners, a high outflow (especially in the 35-55 year group) and too limited inflow threaten the continuity of care.
Despite everything, general practitioners are still able to answer 95 percent of healthcare questions for 5 percent of the total healthcare budget. And that cost percentage has hardly increased in recent years. Just as the number of patients per standard practice has remained the same, despite the increased demand for care and disease burden.
In our opinion, it is not surprising that general practitioners indicate that they are drowning in work. It is strange that they are listened to so poorly. Because general practitioner care forms the foundation on which our entire healthcare system rests and builds. Without this foundation, there will be no appropriate care and no right care in the right place.
That’s why we say: don’t always ask what your GP can do. See what you can do for the GP so that primary care can continue to ‘run’ in everyone’s interest.
Medical specialists:
- Be careful when outsourcing tasks and assignments to the GP. Just because a GP can do a job does not mean he can be involved. The fact that healthcare providers in, for example, hospitals or mental health care are sometimes unable to meet the demand for care does not mean that general practitioners can take on additional tasks. They are not there to tie up loose ends elsewhere in the healthcare chain. If a GP is upset with a patient because things are no longer going well at home, help where possible. Thinking along, sympathizing and sometimes also cooperating. Organizing home care is an increasingly difficult task, especially in the final phase of life. Sometimes it simply doesn’t work at all. And then? Hospitals can close their doors during busy periods, but general practitioners cannot. Think about that and don’t immediately shout: ‘But we have finished treating this patient!’
Paramedics
- An urgent request to provide ‘the right care in the right place’; think along at a more organizational level. Does it make sense to send a patient (back) to the GP? Will he be able to resolve the complaint or would someone be better off with a colleague in primary care or the social domain? Consulting by telephone about a follow-up plan is enormously helpful.
Health insurers and politicians
- If young general practitioners are willing to build or take over a practice; then help them. They take on a major (social) responsibility, which means that health insurers can meet their legal duty of care and the government can also meet the legal duty to guarantee good access to health care for every Dutch person.
- Realize practice reduction while maintaining income. This means that the number of patients per standard practice will have to be adjusted downwards, so that general practitioners are able to continue to answer the more demanding care demands of their population themselves. We expect that this will also lead to a progression of observers to practice ownership.
- Make housing for primary care providers a shared responsibility of municipalities, health insurers and healthcare providers. You cannot create neighborhoods for tens of thousands of new residents if public facilities are not organized within the same postal code area.
- Finally, the government It is time to create a healthy living environment and to focus broadly on prevention, information about the use and scarcity of care (especially outside office hours) and encouraging self-reliance in a society that is becoming increasingly feasible and at the same time increasingly vulnerable.
#busy