A far cry from the UK practice

Few GPs in central Europe treat children, and audits are again lacking, finds Dr Gerald Michael

The fourth leg of my journey around Europetook me through the centre of the Continent.

I visited Slovenia, Hungary, Slovakia, Austria and the Czech Republic, in many ways similar to each other, but all profoundly different from the UK NHS.

In all but Austria, the GPs in these countries do not look after children, who are instead treated by primary care paediatricians. In Austria, the doctors not only look after all children and babies, but work without health visitors and do about four screening checks in the first year. As in Greece, they give the immunisations themselves.

In none of these countries do the GPs practice any form of gynaecology. Instead there is a special group of doctors called gynaecologists who work in primary care. They sometimes share premises with GPs in large clinics, such as in Slovakia, or work alone, as in other countries. They are not gynaecologists in the UK sense — they do not have hospital beds, or perform Caesarean sections or hysterectomies. 

Practical differences
I was told that in Slovenia it is forbidden for GPs to perform  vaginal examinations and none of the GPs in the other countries ever did them, although some thought it might be different in the countryside if a  GP works in a village a long way from where a gynaecologist could be found.

In all of these countries the GPs are single-handed. In Slovakia the doctor I spoke to worked in a polyclinic of 40 doctors, but they all worked on their own. In the other countries the doctors are alone in their building. Staff are few and far between — in Austria they do not have practice nurses. 

There is a curious system in Slovakia and the Czech Republic where before seeing the doctor, a patient must first go through to the nurse’s room for administration tasks such as being logged on to the health system and recording their BP. They are then released into the doctor’s room. This way, of course, means that both health professionals must synchronise their appointments.

Much of the nurses’ work is administration because the GPs either employ nurses or receptionists — but not both. None have practice managers.

Notes are mostly taken on paper, although in Austria the doctors use computers. However, there appears to be no common IT, and no templates, so audits are not done.

I have not been to a country outside the UK where doctors are paid to reach targets, and the doctors I have spoken to also do not seem interested. It will be interesting to see over the years if the morbidity and mortality of cardiovascular disease falls faster in the UK than in these countries.

The doctors in all these countries do house calls; mostly about two a week. For this they are either not paid at all, or only paid a trivial amount.

Again, Austria is the exception. Here the pay for visits is substantial and, possibly associated with this, the doctor I spoke to does about five a day.

Reaccreditation
Plans for reaccreditation in these countries are bound up with medical education. All GPs are expected to do a certain amount, including lectures, attending conferences, interactive course work or completing MCQs from journals. 

In Slovenia, doctors have a target number of points to acquire over four years, and theoretically would be struck off the register if they failed.

Similarly, in Hungary, doctors must acquire a set number of points over a five-year period or face being removed from the register.

In Slovakia, if doctors don’t have enough points in five years, they must take an examination, and in Austria a three-year period of accumulating points results in a certificate which needs to be renewed after this period. If points are not collected, there are no sanctions other than not receiving the certificate.

Dr Michael is a retired GP from London

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