New organization of general practice in Norway from 1 January 2007

In 2006 two days in May were “red-letter days” in the history of Norwegian general practice! On 4 May the Norwegian Association of General Practitioners (Aplf) held its annual general meeting where the delegates unanimously voted to dissolve the Professional Development Committee, which for many years had worked within the organization on the development of the general practice specialty. Aplf, hereafter called Allmennlegeforeningen (Af), was from 1 January 2007 to be entirely a union with main responsibility for the GPs’ union policy. Later that same day at the Norwegian College of General Practitioners’ annual general meeting it was also decided, by a vast majority, to dissolve the College with effect from 1 January 2007. The following day the new specialty organization, Norsk forening for allmennmedisin, the Norwegian College of General Practice, was founded. This organization is to be in charge of general practitioners’ professional development.

We now in Norway have two organizations of general practice under the umbrella of the Norwegian Medical Association: Allmennlegeforeningen is solely a union, and Norsk forening for allmennmedisin is purely a specialty organization (College). The two organizations have more or less the same membership figure, approximately 4400.

Much of last year was taken up with these organizational changes. We have established a joint website: http:www.legeforeningen.no/allmennmedisin. Joint news will be posted here and there will be links to the organizations’ individual websites. The new specialty organization has its own website: http://www.legeforeningen.no/nfa

The new Board of the Norwegian College of General Practice (Nfa) has held some meetings and has drafted a policy statement [1]. The two most important issues for the Board, besides constructing the organization, have initially been the recruitment situation in Norwegian general practice and research in general practice.

Recruitment to Norwegian general practice

Some aspects of development in Norwegian general practices are a cause for concern:

• GPs’ working hours have increased by 6–7 hours per week to 49 hours per week (not including on-call time) since the introduction of the listing system in 2001.

• The age of GPs in Norway tends to be increasing. In 1995 the average age of GPs was 43.5 years; in 2006 it was 47.1 [2].

• The number of women among GPs is still low. The increase in female GPs is less than half of the increase among all working GPs [2].

• The number of GPs in Norway has hardly increased since the introduction of the listing system. Only around 27 man-years out of a yearly net increase of approximately 440 new doctors have been put into general practice. This means that general and social medicine yearly gets only 6% of new Norwegian doctor man-years. The hospitals swallow up the rest [3], [4].

• The number of specialists in general practice in Norway is since 2004 no longer on the increase. Lately the number has been declining [5].

In their daily work GPs experience an increasing workload with greater expectations of collaboration with various authorities. GPs are more and more involved in care of the increasing number of elderly, of chronically ill patients, and of other important patient groups with complex health problems, often with psychiatric disorders and/or substance abuse with subsequent withdrawal from an active working life.

We are concerned about the future of Norwegian general practice, if this stagnation in recruitment continues. We are particularly worried about the GPs’ chances of satisfactorily undertaking and performing the increased workload/tasks imposed upon them within the fields of, for example, substance abuse, psychiatry, cross-sectional work, sick-listing, prescribing for the elderly in nursing homes etc. Adequate treatment offers for patients depend on the listing system being properly dimensioned and allocated the necessary resources.

Norwegian general practice must offer a guarantee of the necessary quality and collaboration, as well as necessary professional development and research. General practice must be an attractive option for young doctors, and attractive as a final career choice.

There are probably a number of reasons why we are experiencing this recruitment failure in Norwegian general practice. Young doctors seem to find the professional and social network provided in a hospital setting fundamentally important. In the specialist healthcare system time and resources have been allocated for professional development and specialist training of doctor trainees within normal working hours. The specialist healthcare system has shown a great capacity for receiving young, newly trained doctors. The specialist training in general practice is decentralized and solidly professionally embedded, but can still be felt to be difficult to navigate around and it is to a great extent based on the individual's initiative and willingness to spend leisure time and invest his/her own resources.

It is our opinion that a number of different initiatives should be implemented: various professional incentives like strengthening of the supervisor offer, widening of the professional network, assessment of the specialist training programme, speciality in general practice obligatory in order to work independently as a GP, various initiatives for uniform national quality and responsibility criteria for the on-call system, clarification of recruitment or GP trainee positions etc. When the research units of general practice are up and running, it is the intention that it should be easier for GPs to be part-time researchers alongside their work in general practice. And the listing system scheme must be allocated sufficient funding for the GPs to carry out their jobs.

The Norwegian College of General Practice has, together with the Norwegian Association of General Practitioners, taken the necessary steps in relation to the parent organization and authorities to secure Norwegian general practice in the years to come. We look forward to its continuation.

Research in Norwegian general practice

Four new research units in general practice are now a reality in Norway!

The Norwegian general practice organizations have, jointly with the academic institutions, for a long time worked to strengthen Norwegian research in general practice. We have looked to Denmark and their three great research units in general practice.

In 2006 it became clear that the government would allocate funds from the state budget for the establishment and running of four research units in general practice, one in each university town, and all strongly affiliated to the respective universities. In addition, as a result of the negotiations for Norwegian general practitioners in 2006 a general practice research foundation with grants for NOK 2 million thus far was established. The purpose of the foundation is to promote research in general practice on the GPs’ terms and contribute to the establishment and national coordination of activities in the four research units. The Norwegian Medical Association will shortly appoint a Board for this research foundation, and the foundation will thus be in operation later this year.

So far sufficient funds have not been allocated in order for the research units to secure satisfactory basic operation, but we are optimistic and believe that the Government will grant sufficient funds in the next couple of years. In addition, we are working on making the Norwegian Medical Association's research foundation considerably bigger, thus making it an important source for Norwegian GPs to apply to for funds.

We hope and believe that the sum of the governmental aims and a large and strong general practice research foundation will result in a considerable and important strengthening of Norwegian research in general practice in the future. We shall look forward to that! Gisle Roksund Chairman, Norwegian College of General Practice Oslo, Norway E-mail: [email protected]