Clocks, watches, mountains, and trains. Clean Swiss efficiency. So, I was fascinated to learn about Swiss primary care when speaking at a recent conference in Lausanne; mostly single handed, still predominantly male, and with limited use of electronic records. Joining me from the UK was Stephen Campbell from Manchester, one of the architects of the quality and outcomes framework, and together we described both the theory and reality; from an overall perspective to day to day practice. Accepting that there are imperfections, it was a privilege to acknowledge the achievements of UK primary care. Concepts of quality and performance, which we now take for granted in the UK, were new and a little threatening for our audience. As in many countries, GPs are concerned about government motivation and worried about control. more…

As a locum GP, I tend to have limited contact with the permanent staff of the practices I work in, and I therefore rely almost entirely on myself to look after my professional development (there is currently no revalidation scheme for doctors in Portugal).

Once a year I try to visit and shadow a prominent GP for a few days somewhere around the world in order to gain new ideas and inspiration that can help me improve my work. I decided to travel to Aarhus, Denmark, and visit Per Kallestrup, who is the initiator of the Hippokrates programme, a popular European exchange programme for GP trainees and GP’s. Dr Kallestrup is, along with seven other colleagues, a GP partner at Skodstrup Laegepraxis, a surgery in the outskirts of Aarhus serving about 12 000 patients. more…

Here is my third and final blog on the USA trip: After Seattle’s integrated care organisations, we visited CalPERS. They fund $6.7bn worth of healthcare for 1.3 million people (roughly twice what we have per person in Lincolnshire). They see themselves as “active” purchasers: managing the market to reduce costs. About two thirds of their members are in capitated plans (for instance Kaiser) whilst the remainder are in a PPO plan (Preferred Provider Organisation). Simple examples of their interventions were to remove co-pay from preventative care for members, to have fiscal and chronic disease management targets and to set a tariff for knee replacement–it all felt familiar. What wasn’t was their analysis by price for knee replacement. It revealed a staggering variation from $15k to $120k. With 46 hospitals they agreed a tariff of $30k but patients could choose to use hospitals that refused the tariff – so long as they paid the difference. It made me think why a tariff for planned procedures may not be such a bad idea. more…

Back in May 2010 the professional executive committee and NHS Lincolnshire board agreed to delegate the management of the minor surgery local enhanced service to the practice based commissioning (PBC) Groups.  A lot of discussion and analysis had taken place prior to this decision. Practices had said that the historical budget was insufficient to meet demand and that without  investment GPs would be forced to make a referrals to hospital based services which would cost more. Concerns were raised about managing demand, the appropriateness of the surgery and whether increasing investment in primary care services would have any real impact on referrals into secondary care. Out of the debate emerged the “experiment” which the Board sanctioned. more…

The TV programme My big fat gypsy wedding made me cringe. We cared for a large community of travelling people for many years and I felt embarrassed on their behalf. Some traveller women I spoke to felt let down by these programmes. The cold documentary eye made the lavish weddings and extraordinary dresses look absurd. They were betrayed by subtle ridicule.  Was this appropriate? Did they really appreciate how they would be portrayed? more…

One of the major advantages of being an active member of listservers, particularly international ones, is that I am in touch with leading colleagues around the world, and also I can learn about issues and think in ways that I would not otherwise have become aware of. I’ve had the chance to cross paths a few times with Dr Juan Gérvas, a towering figure of international general practice based in Spain, and a professor of primary care, public health, and management at several Spanish universities. more…

“Research highlights” is a weekly round-up of research papers appearing in the print BMJ. We start off with this week’s research questions, before providing more detail on some individual research papers and accompanying articles.

• Is ethnicity related to academic performance in doctors and medical students trained in the UK?
• Does weekly ultrasound treatment improve hard to heal venous ulcers?
• Has the survival of patients with cystic fibrosis who have low lung function improved over the past 20 years?
• Do older residents in care homes receive poorer quality care for chronic diseases than residents living in the community?
• How much published research on primary care is authored by primary care researchers, and how good is it?
  more…

Every year my family tease me about going to NAPCRG, the North American Primary Care Research Group. This is pronounced “nap crag” and it does not take a huge leap of imagination to see how a little mispronunciation may lead to a sequence of “funny” jokes.

As a result of this and partly to get people thinking about the focus of the meeting, last November, I asked the NAPCRG audience of 700 researchers what name they would like. As there was no ethics application I am unable to share the results but the question resulted in plenty of suggestions and discussion. The variety in response partially reflects the fact that we are called primary care physicians, general practitioners, family doctors, and other terms depending on our country and scope of practice. more…

When Davidicus Wong (cool name) told of being asked by a fellow passenger on a plane “Are you a GP or just a just a specialist?”, it set the scene for the Impact BC Canadian Health Improvement Forum, which preceded the Institute for Healthcare Improvement meeting (10th Annual International Summit on Redesigning the Clinical Office Practice) in Vancouver. During a break, a GP who has been in practice for 30 years in Fort St John about 800 km north of Vancouver, told me he has never enjoyed general practice so much. Something is happening. These doctors enjoy their work, talk about it being fun and rewarding, and invest huge time and efforts to improve their practice. more…

My practice recently revamped its provision of short-notice medical appointments by transforming the Emergency Surgery into the (so far so good) Rapid Access Surgery. In essence, patients can now no longer pitch up to the practice between 11 am and 12 noon and definitely see a doctor regardless of their complaint, or lack thereof. more…