How we are trying to ensure strong general practice in Denmark

Following on from Pulse’s look at general practice across the world last year, Dr Jens Søndergaard says Denmark’s close-knit community is one of the reasons why general practice in the Nordic country is staying strong in trying times

Last week, I caught up with a friend who works as a GP locum in London. After talking about the weather and other trivial matters, he told me something I found surprising: he could not find any work.

He filled me in on the employment crisis facing UK general practice, particularly how GPs are being replaced by cheaper, less-qualified staff via the ARRS. I personally find it hard to believe that GPs are sitting at home twiddling their thumbs, because in Denmark we have the opposite problem of not having enough GPs.

Consequently, our workloads are becoming increasingly unmanageable. This was recently compounded by the Danish government’s decision to change the funding model of our hospitals, moving them from the fee-for-service payment system to a fixed-budget framework. General practices quickly felt the repercussions of this shift, as hospitals started hesitating about accepting referrals.

The truth is, no matter where you are in the world, the profession is under strain. Around a third of Danish GPs suffer from burnout, and research suggests this is down to an increase in workload, especially administrative work. We simply do not have the time to consult our patients like we used to – and that’s frustrating because most GPs want to talk to patients, not spend hours doing meaningless paperwork.

There is also the issue of pay. We are better paid than hospital doctors – the average GP salary in Denmark is 1,250,000 DKK (£143,000) – but we have a salary ceiling that prevents us from being remunerated for all the additional hours we work. I believe that general practice is a prestigious profession, and the pay we get should reflect that. 

As a result, negotiations have started in Denmark regarding the upcoming collective agreement between the regions and the organisation of general practitioners. The demands have not yet been presented, but the regions are focused on improving accessibility and having greater control over general practice. The overall financial framework has not been significantly increased, despite a consensus between the regions and the state that general practice needs to be strengthened in the country.

We need to protect our profession now more than ever, as pharmacists have been pushing to treat patients. Although they play an important role in our healthcare system, they specialise in drugs, not treating patients. I really hope that our government will not replicate the UK’s Pharmacy First scheme.

But as things stand, we do not have to deal with the implications of a ludicrous scheme such as the UK’s ARRS. With the number of vulnerable patients with multi-morbidity rising, and treatments becoming more intricate, it’s imperative that the person who provides them is highly qualified. It’s difficult to imagine anyone other than a GP being suitably qualified to take on these responsibilities. 

The solution to the UK’s workforce crisis does not lie in parcelling out the GP’s duties across numerous hands and professional expertise. Instead, there should be a staunch commitment to the education and employment of more GPs. By bolstering the qualified workforce in general practice, we are in the best position to meet the healthcare challenges of the future and ensure continuity and quality in patient care.

I think the fact that we prioritise continuity of care is one of the reasons why GPs in Denmark are highly respected.

The sense of community and collective effort in addressing the task was key to managing events effectively and avoiding significant controversies. It is heartening to witness how different sectors of society can collaborate to manage crises such as these in ways that support both individual health and the wellbeing of the wider community.

We have always prided ourselves on providing excellent access for our patients. At my practice, patients who show up between 10am and 11am will be seen the same day, whether they have a minor injury or an acute problem. After all, anything and everything is urgent to them. If they turn up, they’ll be seen.

The idea of having to redirect patients to other services like in the UK is shocking. But I think Denmark benefits from being a small country, with smaller cities. We all know each other and that has a huge influence in terms of how we treat each other. If I tried to turn a patient away, I would probably bump into them in the supermarket the next day. We are a close-knit community, and knowing each other is very important. I think that’s why we prioritise continuity of care to the degree that we do.

I have known most of my patients from when I first started working as a GP. I know how to address them, and they know how to address me. Perhaps a simple approach works best.

Dr Jens Søndergaard is a part-time GP in Middelfart, Denmark