Leaving Estonia, we crossed by ferry to Finland and then on to Sweden and Denmark.
General practice in Sweden and Denmark is more similar than different, and not unlike the UK. GPs tend to work in groups — the practices I visited were two to four whole-time-equivalent doctors. Dif- ferences worth noting are that the Swedish GPs are salaried, but in Denmark the GPs are paid capitation and item-of-service fees for consultations and visits.
Swedish patients pay a small consultation fee to the clinic, which does not go to the doctor, but for Danish patients, general practice is free.
In the Swedish practice I visited, the doctors have no time for visits and leave them to the emergency services. In Denmark the GPs do their own.
General practice in Finland, while being advanced, seems to be in a world of its own. The community health centre that I visited was vast and served the local community plus a smaller adjacent one. It had 17 GPs and seven trainees.
Patients see any doctor, so there is little continuity of care. The doctors are salaried but the patients pay either annually or on a per consultation basis.
The clinic has many other services, including primary care beds. Two of the GPs look after the beds and do most of the visits.
Vocational training in Finland is a choice of two years with no final assessment or a six-year course with an exam at the end to become a specialist in general practice.
What I found strange in Finland is that patients can see private GPs with the same discounts for medication as if they saw community doctors.
Many employers have contracts with occupational health physicians who, as well as giving statutory work-related medicine, provide GP-type services with the same prescribing rights.
The three systems do not communicate with each other so there may be duplication of investigations and treatment.
All three countries run some sort of out-of-hours services with GPs. In this area Sweden is the most individual. The service starts at 5pm, but from midnight until the next morning, as in Lithuania, there is no primary care and patients must either go to A&E or call an ambulance.
- Dr Michael is a retired GP from London
- Next week: on the home stretch, Dr Michael visits Holland, Belgium, Luxembourg and France