Lessons learnt from a European trip

Returning home from Europe, Dr Gerald Michael reflects upon the good and bad of UK practice

Having interviewed GPs throughout Europe, I have returned to the UK feeling more positive about UK general practice than before.

We British GPs are lucky to work in primary healthcare teams with secretaries, practice managers, receptionists and, above all, nurses.

We do not have the sense of isolation found in much of the EU. We suffer from micromanagement from the state with frequent changes in our terms of service but this also happens abroad.

We can be proud of our ability to seek out and manage chronic disease using a systematic approach involving targets, templates and audits — these are hardly found elsewhere in Europe. As a result there appears to be an improvement in our morbidity and mortality of, for example, cardiovascular disease.

Although I feel generally upbeat about the UK compared with the rest of the EU, there are some points that are worthy of further discussion.

Keeper of records
UK GPs are happy to be the sole holder of records, giving the patients the advantage that the GP has all the information for referrals and necessary for passing on to the next doctor when the patient moves.

To make this work, patients cannot see specialists either on the NHS or privately without our referral.

Abroad, records often do not follow the patient and in most countries the patients can see other GPs and specialists, at least in the private sector, without the GP’s knowledge or assistance. They still get the equivalent of National Health Service prescriptions.

However, patients in the UK being forced to register with a GP near where they live and often commuting to work can make access to the doctor complicated.

Range of work
Many GPs in other countries do not take on paediatric or gynaecological work. While I think our system is right for us, because most UK GPs learn these specialities in vocational training, I think that there should be a method of opting out.

Out-of-hours
Although most countries work on the co-operative system, some stop all primary care during the night and others in evenings and weekends. In these cases patients have a choice of going to A&E, sending for an ambulance or seeing a private doctor.

The last option would be politically unacceptable here but the prevalence of these services made me think it is time to debate the need for out-of-hours primary care.

On the whole I have returned from Europe a happier and (I hope) a wiser man. 

Dr Michael is a retired GP from London

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