19 May, 09 | by BMJ
An extra 2000 GPs were promised when the Minister of Health in Norway heard Barbara Starfield speak on a previous visit to Scandinavia. Roar Maagaard, in quoting this figure in his introduction, was sorry that the Danish Minister for Health and Prevention, who opened the conference, left before her keynote address at the 16th Nordic Congress of General Practice. She is a key advocate for primary care. Her summary of the health benefits of primary care in Indonesia, Thailand, and Brazil was impressive. There is no doubt that primary care is effective in reducing population standardised and infant mortality and reducing inequity. And her review of mortality figures across US states was strongly supportive of a primary care based system. In the US, of course, this includes a number of different primary care providers including paediatricians and some internists, not just family doctors. It was interesting that she used traditional public health measures as her outcomes and she spoke of person focused care-not personal care, being careful to point out the need for more evidence in personally tailored health care.
Beside, I am not sure how much effect her evidence would have had on local policy. The 700 delegates, the majority of whom were Danish, took a collective sharp intake of breath as they listened to their Ministers plans. In a refrain familiar to UK general practice, he spoke of the need for reform and specifically identified two key areas: chronic disease management pathways and building larger groups of general practitioners with collaborative skills.
Mikkel Vass and Linn Getz, focused more on the traditional personal doctor in their witty and entertaining addresses. Mikkel took us on a flight simulator as a metaphor for general practice while Linn used the music of Van Morrison to illustrate the soul of clinical care. I liked Mikkel’s comment that life was a long journey with a fatal outcome and his main message of the need for sustainable care for the elderly. Linn presented research on brain plasticity with evidence from neuroscience and, ultimately, a fascinating hypothesis on the effect of healing; that we might change the brain.
This was a very different conference. Among the 700 delegates were a just handful of North Americans and very few UK GPs. Listening to speakers describe their primary care system as the envy of the world, I couldn’t help but smile at the familiar rhetoric. We try to convince ourselves of this in the UK as general practice lurches, seemingly rudderless, from one reorganisation to another. But, somehow, I believed it more in Copenhagen.
The conference ran like clockwork. There were healthy food options at every meal and an endless supply of fruit, vegetable snacks and healthy drinks. I didn’t see a single overweight doctor. Spring was in the air, there was an endless trail of joggers on the lakeside path outside the hotel and, the city was a mass of cyclists. This country works, and its healthcare system seems to work too.
Domhnall MacAuley is primary care editor, BMJ