the DN Debate published on 28 september, a läkarupprop for a national primärvårdsreform. Now has 1364 primary care physicians to put his name on the letter. The background to the appeal is that the Swedish primary care is undersized, underfunded and is characterized by lack of general practitioners. Why can’t the general take care of their patients, which leads to low availability, deterioration of medical quality, unnecessary hospitalizations, överdiagnostik, overtreatment, and not least human suffering. The care that is more efficient and simpler could be managed in primary care, passed on to hospitals and their emergency rooms.
the Healthcare system is in a deadlock situation where the necessary changes of patient flows to and from the hospitals can not be achieved. It leads to long waiting times and that health care draws large unnecessary costs. To change this requires a thorough primärvårdsreform which in principle all agreed, we who work in the care sector, patient organisations, investigators and politicians. Despite this, very little has happened in several decades.
. A full-time doctor’s list must be limited to a maximum of 1500 people. The principle of the doctor and listtak is necessary to ensure that patients with the greatest health needs are prioritised by a qualified medical assessment by a doctor with personal responsibility. It would also make it more attractive for doctors to work in primary care.
another intriguing example is the Bergsjöns medical center. This determines the patients themselves when, and to what doctor they should come and interpreters are employed on the reception. Here are the doctors on the line to get to work.
There is evidence that continuity and personal knowledge between the doctor and the patient reduces mortality and morbidity saves resources and increases patient satisfaction. In Sweden know only slightly more than 40% who is their fixed doctor. In comparable countries have 80-90% of a doctor. There, Sweden must reach in order to be able to realize a good and close, effective care.
in Order to meet the rapid development of knowledge in the medical field and within it, is also a strong commitment to continuing education. It is a day severely deprived area, in particular in primary care. In addition, the need for a national strategy to train and recruit general practitioners.
the Requirement of a doctor and listtak does not contradict to other health professionals, for example, a district nurse, at the same time can serve as a solid care contact. All based on the patient’s needs.
In an article in SvD is opposed to the leadership of the Swedish association of local authorities and regions, SALAR, a targeted national funding of educational services in general medicine, listing on the doctor, as a principle, and a national listtak.
the absence of national regulation unacceptable local variations in both the work environment such as accessibility and patient safety, and thus contribute to unequal medical care.
the county council to the governance of primary care has, for decades, been through nitpicking. It signals a lack of trust in the profession. For example, when it comes to the lifestyles of governance penetrated all the way into the konsultationsrummet. The guidelines provide not only what the doctor is going to talk about, but also how the call shall be in the personal meeting, in violation of a patient-centred patientsamtal. Follow the guidelines, it may result in loss of compensation. It is time to immediately abandon this counter-productive micro-management and instead put seriously behind the prime minister’s words, ”let the pros be pros.”
Even if the capacity and the quality falters in many places in the primary, so there are several good examples that shows how successful it is when the profession control of the health care form:
• The health center is an example. the Reception has undergone a radical development from the hyrläkarberoende to the full team where each doctor has a list of 1000 people. The high läkarkontinuiteten has made a bet on home care, which is directed to the people who have the largest and most costly health needs.
By establishing a close cooperation with the municipality, the ambulance, and Kalmar hospital, the number of unnecessary and expensive hospitalizations decreased significantly. Hälsocentralens manager, the general practitioner Åke Åkesson, has coined the term ”hemsjukhus” and demonstrated how big savings can be done at the same time as the care and security of the very sickest improved. It gives an indication of how large values, both human and financial, which would be won if this model could be implemented on a large scale.
• another intriguing example is the Bergsjöns medical center in the outskirts of Gothenburg, a invandrartätt area of great social vulnerability. the general practitioner Christer Andersson has implemented an innovative adaptation to the conditions of the area. This determines the patients themselves when, and to what doctor they should come and interpreters are employed on the reception. Here are the doctors on the line to get to work.
• an inspiring role model Storumans infirmary , which the general practitioner Peter Berggren during several years developed the digital technology to overcome the distance in rural areas.
• On the island of Gotland has the general practitioner in the True Althini through the dedication and persistence they managed to create a pilot project where you are investing 20 per cent of the doctors working in training and development. A principle of the quality of care and patient safety should be a role model for the whole country.
and that shows that the activities in primary health care is based on the professionsstyrning and trusting of continuous vårdrelationer in-person meetings reduces costs and at the same time make healthcare both more equal and better. This view finds support in the investigation of the ”Effective health care” (SOU 2016:2).
We believe:
• it is a prerequisite for a functioning health care, let the pros be pros and to give the medical profession the confidence to guide the design of practical health care according to scientific evidence and measurement of the patients ‘ needs.
• Because primary care has been severely neglected for decades, it is now urgent to implement a long-term national primärvårdsreform with increased resources .
• For the quality of care, patient safety and equality, it is an economic necessity that each inhabitant is guaranteed a fixed primary care physicians with good availability and assured competence.
