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At the heart of general practice since 1960

Can't contract make practice this good?

The contract gave us the chance to reform the health service, but this has not happened.

I recently spent a week in Denmark as I wanted to see a health care system that works reasonably efficiently and where patient satisfaction remains high.

GPs there are paid by a mixed system of capitation fees and fees for item of service. This seems to improve job satisfaction, as well as the quality of care delivered. It also reduces paperwork and staffing needs.

For example, after 2pm, only GPs are present in the practice and patients only phone at

this time if it is an emergency.

Why has this system not been considered in Britain?

Also, GPs are seen as specialists, on an equal footing with specialists in hospital.

GPs are only responsible for care from 8am-4 pm. After-hours care is based in the hospital, and this is free at point of service. This allows ease of access to radiology and ease of communication with other specialties.

A few other interesting ideas: very good use is made of IT (information about emergency visits is e-mailed to the GP for the next morning). Clinical governance has largely meant provision of funding for ongoing education. Also, relatively few consultations are about minor complaints. It would be interesting to find out why.

Dr Natalie Chersich

GP Registrar

Burgess Hill

Sussex

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