Denmark
The situation in Denmark
Dr Peter Mortensen
In Denmark, all 3,400 general practitioners are organised in the
Organisation of General Practitioners in Denmark (PLO). The
Organisation negotiates agreements with the public authorities, and
at the same time, handles the interests of genera] practitioners in
Denmark, with a particular view to ensure the identity and
development of general practice.Thus, the Organisation is deeply
involved in adapting the requirements for specific training in
general practice in Denmark to the requirements formulated in the
UEMO Consensus Document on Specific Training.The development of
continuing medical education (CME) courses for general practitioners
and the assurance of CME among general practitioners are both highly
prioritised on the Organisation's list of activities. Similarly,
efforts are made to further quality assurance projects within
general practice. Obviously, this broad range of activities require
that the expectations and views of the members are taken into
consideration.
Study on general practitioners in Denmark
Accordingly, the Organisation has tried to determine the
expectations and wishes of its members by means of an extensive
questionnaire study performed in 1996. With a reply percentage of
82.5 in a questionnaire consisting of 110 questions, a study is now
available with substantial, rich, detailed, and representative
statistical material elucidating general practice in Denmark today.
The study provides important information on the views and attitudes
of our colleagues and gives further possibilities for clarifying
questions related to general practice.
General satisfaction with the Agreement
The study revealed satisfaction with the existing general
agreement between general practitioners and the public authorities.
Satisfaction was also expressed with regard to the work in a liberal
trade, under an agreement which offers free medical care in general
practice to all citizens.According to the agreement, the doctor
receives a fee from the authorities based on an enrolment system in
which fees are paid according to the number of patients enlisted
with the individual practitioner and the individual contacts between
patient and doctor. In addition, an amount is paid for a specified
range of services in connection with the consultations, ie, a system
which ensures a basic income for the individual doctor to cover his
or her cost related to the clinic. At the same time, this motivates
a higher level of activity in general practice, with the possibility
of quality assuring and steering the activities of general practice
by means of financial control of a number of specific services.
Daily working conditions/work time
The study also expressed general practitioners' satisfaction with
daily working conditions. In Denmark, these are defined by the
general practitioners themselves, as well as by the wording of the
agreement with the authorities. The individual doctor finances the
establishment of his or her clinic paying their own secretary and
nursing support. The number of patients enlisted with a general
practitioner (a figure which has certain limits in accordance with
the Agreement) is a means of defining daily workload.According to a
European study, general practitioners in Denmark have an average
working week of 47 hours. Of these, five hours are placed within the
out-of-hours time, ie, between 4pm and Sam on weekdays, the weekend,
or during public holidays. The general practitioner has an
obligation to take part in out-of-hours arrangements.A particular
problem in relation to work time is an increasing public wish to
involve general practice in the acute workforce at the emergency
wards, ie, within the hospital sector.Approximately half the general
practitioners in the study found that their weekly workload was so
heavy, allocation of additional tasks to general practice was
unacceptable. Another 50 per cent of general practitioners in the
study found that the part of the emergency functions which may
naturally be described as a general practice service should be
performed by general practitioners within the existing duty
arrangements, with compensation of the increased workload in the
form of more doctors within general practice.The above must be seen
in light of the fact that in Denmark, general practitioners cannot
establish themselves freely under the General Agreement, thus
medical care is offered free of charge. This results in a situation
where general practitioners working outside the General Agreement
are practically nonexistent.
Shared practice
The study further revealed a need for shared practice. This
concept has become increasingly relevant in Denmark and must be seen
in the context of the existing Agreement's regulation of
establishment possibilities, combined with an increased workload in
general practice. Shared practice gives the doctors the possibility
of sharing a 'practice right'.The need for shared practice is
related to another problem also revealed in the study. In Denmark,
as in a number of other European countries, there is a tendency for
general practitioners to retire early. Furthermore, Denmark has
experienced strong control over training for general practice, which
will result in a considerable lack of trained genera] practitioners
within the next ten years. The idea of shared practice, which has
yet to be implemented because of a number of practical obstacles, is
seen by many as an important innovation within work flexibility in
new agreements.

Dr Peter Mortensen, Head of UEMO Danish Delegation
Specific training/CME
In Denmark, specific training for general practice includes one
year in a general practice clinic. The study showed that
approximately 50 per cent of general practitioners wish to enter
agreements with a view to participate actively in the training of
future colleagues. Approximately 40 per cent of general
practitioners consider it natural to require continuing and
obligatory medical education in order to maintain their specialist
recognition. Only some 33 per cent of the general practitioners in
Denmark have not participated in research projects at some level.
Some 50 per cent of general practitioners take part in quality
development projects, while half are involved in a quality
assessment arrangement with colleagues from outside.As stated in the
description of the study, it gives 'a picture of general
practitioners who are engaged in their patients and in the work
within their profession.' At the same time, the development of
general practice is given high priority. This is seen by frequent
participation in continuing medical education, as well as in quality
development and research. Responsibility for the coming generations
is also given high priority, with a considerable number of general
practitioners participating or wishing to participate in the
training and tutoring of general practice trainees. In addition,
general practitioners are ready to engage themselves in new tasks,
eg, prevention activities. However, there is a growing demand for
general practitioners and the study shows that not all tasks are
equally prioritised. The general practitioner experiences an
increasing workload and the wish for improved assistance
possibilities.
Conclusion
Despite the positive status description of general practice in
Denmark, there are still many unsolved problems which must be
negotiated. These are related to working conditions, particularly
the increasing workload in general practice, but also the need for a
retirement policy and the possibility of increased flexibility in
the organisation of the work of the individual practitioner.These
are all problems which will be further discussed in connection with
future negotiations.
|
|