News from the Nordic Colleges of General Practitioners

Thoughts from Iceland

In Iceland there is a fairly well-established and strong primary healthcare system, which is basically a community-based model where most patients have their own GP in a health centre in their community. Maternity care and well-child care are well coordinated and operated out of the health centres, which are all computerized and use the same data system or electronic medical records (the Saga system/program).

Most health centres are state run, especially the rural ones, as well as the majority of the health centres in the capital area. Still, there are a few private-run health centres and private GPs but they are heavily restricted and there has been an insufficient increase in the number of GPs in that field for several years. The Icelandic College of Family Physicians (FÍH) has been advocating more independence of GPs and more freedom to run private GP offices. In the last few years there have been ongoing discussions and negotiations regarding that issue with the Ministry of Health, with minimal results so far. The Icelandic Medical Association (LÍ) has also been trying to keep the matter alive and recently published a report on GPs and their current and future situation comparing it with the other Scandinavian countries as well as the UK. The conclusion of the report was that it is necessary to give GPs more freedom and independence in order for patients to have more choice as well as to diversify the healthcare system, which seems to be moving more and more towards centralization.

GPs in Iceland are a diverse group of doctors trained in many countries, such as for instance Iceland, the other Scandinavian countries, the UK, the USA, and Germany. Since the early 1980s all specialists in Iceland have the right to 15 days of continuing medical education (CME) (of their own choice in most cases) and get paid travelling expenses and up to €1100 for airline tickets per year.

Recruitment and lack of GPs has been a problem in Iceland, as it has in the other Scandinavian countries [1], [2]. Most GPs in the capital area have around 1500 patients listed and rural GPs around 1000 patients. There is still a shortage of GPs and despite the fact that physicians in Iceland are at least 1 to every 280 inhabitants, only 20% of them are GPs.

Greater satisfaction

After a pay dispute with the Ministry of Health in 2002 Icelandic GPs’ salaries were adjusted and are now on the same scale as for specialists in hospitals. This meant a considerable salary increase for most GPs and since then there has been greater satisfaction and optimism. Recruitment has been less of a problem than often before and there is definitely a greater interest among younger doctors in going into family medicine.

There is also increased interest in teaching and developing a better teaching environment. Our teaching programme in Family Medicine is now fairly well established and organized with special teaching positions that are supported and financed by the Ministry of Health. The Icelandic College of Family Physicians (FÍH) published a core curriculum/core content of Family Medicine in 1995, which is now being revised and it is hoped will be published this year. The official training structure is also under revision and the idea is to increase the time spent in family practice versus in hospitals. There is also a proposal to make it possible for GPs to go on with their training and add an extra two years in different fields such as geriatrics and rural medicine and to be able to sub-specialize in those fields.

Quality development has been an ongoing, important issue and the College (FÍH) has taken initiatives to promote quality development and has launched a project to educate and train GPs in cognitive behavioural therapy. According to research in the Nordic countries diabetic care can be improved [3] and plans have been made to optimize the use of the computer system for diabetic patients in order to improve and standardize diabetic care. There have also been pilot programmes sponsored by the Ministry of Health in order to help families with troubled youths as well as cognitive behavioural treatment groups for patients with anxiety and depression run by psychologists in the health centres.

The Nordic network

The spring is often a cheerful time when families and friends celebrate and GPs know better than most people how important family and friends are. The collaboration of the five Scandinavian colleges of GPs and the formation of the Nordic Federation of General Practice (NFGP) [4] is in some ways like a family matter and the spring meeting of the presidents and the editorial board in Copenhagen is like a reunion with old friends and family. We may not see each other very often but are always very glad when we do. We also try to get the whole family together every other year when we have our Nordic Congress. Therefore we hope to see as many “family members” as possible in Reykjavik 13–16 June 2007 when the next Nordic Congress will be held.

Our life in Iceland is already, and will be, very busy trying to make the Nordic Congress of GPs as successful as possible. For us it means already fun-filled days with lots of things to do and lessons to be learned, as always when you take on a challenge. Our group of GPs is now one big team respecting the experience of our older colleagues who have been there before us, and looking forward as well as worrying about what the future holds. How will the weather be for those few days in June next year? Will there be a new deadly strain of flu going round the world? We concern ourselves like every host would do while preparing for the biggest celebration of the year.

To care and to change

Of course we do not stop caring for our patients and do our best in the office. Listening to and taking care of our patients is, after all, the main point of most of our work and indeed every GP's shared experience, whether it be in Reykjavík, Tromsö, Turku, Uppsala, or Aarhus. We know we are dealing with more and more people with chronic illnesses such as diabetes, chronic heart disease, depression, chronic obstructive lung disease, etc. According to several studies physicians, throughout the Western world, are not doing a very good job reaching treatment goals and our healthcare systems are not orientated well enough towards chronic illnesses but rather are built as acute care systems. I believe this has to change. We need a system that can offer competent, continuous, comprehensive, coordinated, and compassionate care for the chronically ill. I also think the GP can play a crucial role in that change.

The bottom line is that we need a well-functioning primary healthcare system with electronic medical records everywhere and good clinical evidence-based care provided by the GP and his/her team. We need better communication between GPs and patients and their families as well as between GPs and other specialists and last, but not least, understanding and financial support from the health authorities.

Vision, mission, passion, ambition

Our vision is to see high-quality family medicine in Iceland, a more respected, growing, stronger field in medicine. Our mission is to recruit more GPs and gain more independence and leadership as well as strengthening quality improvement. Our passion is the satisfaction of our profession and the well-being of our GPs. Our ambitions are to provide socially sensitive, comprehensive high-quality individual care with the relationship of the patient and the GP at the centre. We also feel that we need to be a part of a strong Nordic body of GPs like we see in the Nordic Federation of General Practice.