It's hard to be a Dane these days …

It's hard to be a Dane these days … at least a Dane working within the Danish College, research units and university departments.

We have been preparing the 16th Nordic Congress in Copenhagen [1] in May and the Danish trade union, PLO, is negotiating a new contract with the regions and Ministry of Health.

It is also hard to be a regular Danish practitioner. The contract will probably include proposals for new ways of organizing GP clinics, some kind of accreditation, more transparency, and registration of adverse effects.

Furthermore, it is hard to be a Danish medical student, who now electronically has to choose her/his clinical basic education on the internet!

Nordic Congresses

When you read these lines it is hoped that the Nordic Congress in Copenhagen will be successfully over. Some 700 GPs, half of them from Denmark, attended the conference and had a great experience. Almost 160 presentations of high standard within the seven themes have inspired and encouraged the participants to continue their daily work. Most presentations were within the themes “Complex health care problems”, “Care for the chronically ill”, and “General practice as an integrated part of the healthcare system”.

There is an ongoing – and perhaps never-ending – discussion in the Nordic colleges about the official language of the congresses. At the yearly meeting of the colleges in the Nordic Federation in May it was decided that the local organizing committee has to make its own decision on this topic. So far the colleges in Norway and Finland have decided that the official language will be English with some tracks in the Nordic languages. At the same meeting it was decided to try to establish a Nordic organization of trainees – a Nordic Vasco da Gama group – in order to attract more trainees to the congresses. Perhaps we will see this new group at the next congress in Tromsø, 14–17 June 2011.

New contract

The negotiations concerning a new contract are expected to be finalized by the end of May 2009. It is not possible to forecast the future, but we have some indications as to the main topics. In November 2008 a commission published the report “The role of general practice in the future health care system”. There are no recommendations in the report, but a number of analyses that should be taken into consideration in the present negotiations.

There is a lack of GPs in Denmark, the sector has to provide more service to patients with chronic diseases, patients will be discharged from hospital sooner and the young doctors will not want to take over solo practices. Therefore, all agree that we will see bigger practices in the years to come, and the contract will certainly support this idea.

For several years it has been a crucial wish for the health authorities to look into the black box in general practice and see what they are actually doing out there. Our Health Minister has declared that he wants full transparency. We therefore expect to see incentives that will support the necessary IT equipment to register many data in our national database for general practice and a wish or demand to go public with these data. The report from the commission states that quality data should be published at practice level. We have argued against this. Half of the Danish GPs are still working in solo practices, so the published data relate to only one person. We have proposed five practices as the lowest number.

We have also argued that it is more important to establish a culture and organization in general practice where the staff and the GPs together look at the results and find areas for improvement.

In March 2009 the law concerning patient safety in hospitals was extended to the primary healthcare sector. From spring 2010 general practice and the municipalities will register adverse effects in a central database. In this way the GPs will see adverse events they find in their clinics or the events found at hospitals or more likely in the municipalities. Pilot studies have shown that most adverse events relate to mistakes in medication, especially between general practice and community nurses. The purpose is not to sanction the GP but, like the situation with quality data, to establish a culture and organization to learn from these events and to ensure that it will not happen again. There will be no publication of the data at practice level. Once a year a report will be published, which in general terms describes the most common events countrywide.

Basic education

We used to have an internship of 18 months in Denmark. Last year the – now former – president of the young doctors in the Danish Medical Association and the Health Minister jointly agreed on a decision to reduce this to 12 months and named it Clinical Basic Education. The main argument was to reduce the length of specialist training, but other agendas also played a part. The previous model consisted of six months for each of the three specialties surgery, internal medicine and general practice. In the new model the regions create packages of two specialties for the roughly 500 medical students and there will be only six months in general practice in 80% of the courses. The students draw a number in order to choose a package and at a certain date they have 10 minutes to choose one of the available packages.

The system has been functioning for a year now and we have had both good and bad experiences. It is good that the electronic tool works and it is not good that 20% do not have any experience of general practice, but it seems even worse that many of the students have not been working on a surgical ward or in an emergency department. In the commission's report on general practice it says that general practice should have the 24-hour responsibility for the out-of-hours service. This will give general practice more minor emergency department injuries, which the newly educated doctors are not able to handle appropriately.

It has already been decided that candidates who do not have general medicine in their package must spend an extra six months in an introductory post to general medicine and we are negotiating with the health authorities to find a solution for the candidates without surgery in their curriculum.

We hope to have these problems solved before the summer and then during the rest of the year we will try to plan and implement the new elements of the new contract so it will not be so hard to be a Danish GP!