2023-04-26 13:55:21
As a professor, Nynke Scherpbier is responsible for education and research into healthcare in the heart of society. It was not for nothing that she asked the Luthers Bach Ensemble to play these two variations.
Many different doctors, one patient
‘A patient now has to deal with many different doctors and healthcare professionals who are hyper-specialised, so that it is quite a challenge to work well together.’ The state of our fragmented healthcare with its many subspecialties has gradually become unsustainable. This is not only Nynke Scherpbier’s opinion, it is also the message of the many advisory reports that have been published in recent months on the state of Dutch healthcare.*
Highly trained doctors
‘We want to medicalise less, pay more attention to well-being and healthy behaviour, and prevent more. You see the idea of broader, more generalist-trained doctors coming back in many places,’ explains Nynke. Those doctors of the future will be able to discuss and do more themselves before referring patients to fellow specialists. ‘That is why we have the task of paying more attention to generalism and primary care in medical education.’ So make sure that everyone can go without a referral.
Four weeks in general practice
In the first years of their studies, medical students sometimes see lecturers who are general practitioners or geriatric specialists. “For example, they teach clinical reasoning or professional development.” But then. ‘In the Master’s phase, Groningen students do four weeks of internships at the GP. That period is the shortest of all medical courses in the Netherlands and they don’t go to nursing homes at all,’ says Nynke. ‘In Groningen we have developed an innovative internship of twelve consecutive weeks, in which students spend four weeks on geriatric medicine, four weeks on social medicine and four weeks on general practice medicine.’
Internships outside the hospital
During this combined internship, students get to know, for example, elderly people with a multitude of illnesses or working on a healthy living environment at the GGD. ‘We have been instructed to introduce internships in the curriculum after the pilot period,’ says Nynke. But that has not happened yet. ‘You want students with some experience to start such a generalist internship. The fact that it’s not yet included in the Master’s is because the curriculum has a very fixed structure and funding.’
More GPs
Training to become a general practitioner is also a challenge, and not only in Groningen. ‘As universities, we have been instructed to train 1,200 instead of 800 GPs each year. While we receive too few applications to fill the current training positions. And no, it doesn’t help that our profession is often in the news in a negative way.’ Nynke Scherpbier therefore wants to help adapt the training and the setting of the profession, which she knows so well herself and describes as ‘the most beautiful profession there is’, to the current time and generation of students.
Care nearby
‘I envision that soon everyone in the Netherlands will have a small center nearby in which general practitioners, district nurses, welfare professionals and municipalities work together for the same group of people. They are quickly helped with problems with their health and well-being and, if necessary, referred without waiting lists. As a GP you have a lot of autonomy and if you work with a few colleagues and make good agreements, you don’t have to work 60 hours. Especially if those smaller centers are supported by a large regional organization in matters such as ICT, personnel care and finance.’
The North
‘The movement from more care to primary care has been going on for a long time,’ says Nynke. ‘Groninger GPs also seem willing to take over more tasks from the hospital, provided that support is properly arranged. People often have complaints that are related to social problems that do not require medical solutions at all. It does require general practitioners, district nurses and social workers who know the people and their environment. Here in the North, the various healthcare professionals desperately need each other. So if somewhere a successful interplay between zero and first line with the second and third line can succeed at a reasonable distance, it is in Groningen.’
*Those reports, for example, are the report ‘The basics in order’ of the Council for Public Health and Society, de vision of the KNMG and the Board of Medical Specialisms about a new specialty landscape and the Integral Care Agreement.
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