General practice is a highly respected specialty in the Netherlands—what is the secret formula?

Many GPs across Europe will say that general practice is less respected as a specialty compared with hospital-based specialties. In some countries in Europe, general practice is not recognised as a specialty at all.

Undergraduate medical training in Europe continues to be predominantly hospital-centric and it is often difficult in many European countries to recruit new general practice trainees or to maintain, let alone, expand the GP workforce. Levels of burnout among GPs across Europe are high.

But at a working group session called “Value of General Practice” that took place during the recent Autumn General Assembly of the European Union of General Practitioners/Family Physicians, we learned from Wendy Borneman, Board Member of the Dutch Association of GPs, that in The Netherlands general practice is highly respected. According to Wendy, 78% of the population consult their GP every year and 82% of patients have a high level of confidence in their GP. 

General practice in The Netherlands shares common characteristics with other countries in Europe where general practice is highly regarded, like the UK or the Nordic countries. There is a “guaranteed” basic quality of clinical care. GP training programmes have existed since 1971 and every five years GPs undergo revalidation. Maintaining clinical practice for at least two days a week and doing at least 50 hours per year of continuous medical education are part of the requirements for revalidation. Dutch general practice has a strong academic basis. There are professors of general practice in all universities in the country. All GP trainees are trained in academic skills and have the option of choosing to combine their GP training with a PhD. Even though different systems of electronic health records exist, they all have the same standardised format, which makes it easier to carry out epidemiological research.

One of the reasons that general practice is not popular in other European countries is that most medical school training is based in hospitals, so students become more familiar with hospital based training. In The Netherlands, a general practice internship is mandatory during undergraduate training. Teaching is not only patient focused (based on an approach to symptoms and signs rather than to diseases) but also carried out by pairs of GPs and hospital doctors simultaneously so that students gain experience of working with generalists and specialists. General practice is currently one of the most popular career choices among medical students in The Netherlands, and is more popular than other generalist specialties like paediatrics or internal medicine.

What is really impressive is some of the less well-known aspects of Dutch general practice. The Dutch College of GPs has created a patient education website, which has become the most popular website about health and disease in The Netherlands. It is used by 99% of GPs in The Netherlands to provide healthcare advice to patients, is linked to screens in practice waiting rooms, and has led to a 12% drop in GP consultations as patients are able to access high quality evidence based health information online and therefore do not need to see their GP as often.

Wendy concluded the session saying  that it is still not clear what makes general practice in the Netherlands so much more popular than the rest of Europe. It might as well be the combination of all these factors rather than one single thing. The Dutch example is not necessarily generalizable to other countries due to cultural differences.

We all left the session feeling a mixture of admiration, awe, and (healthy) jealousy and wondered how our life as GPs could be different if the value of general practice was more appreciated in our own countries.

Tiago Villanueva is a GP in Portugal, Vice-president of the European Union of General Practitioners (UEMO), and associate editor, The BMJ. The Portuguese Medical Association paid for his travel expenses to this meeting. He has no other competing interests to declare.

Mary McCarthy is a GP in the UK, Vice President of the European Union of General Practitioners and a member of BMA Council. The BMA paid for her travel expenses to this meeting. She has no other competing interests to declare.

Wendy Borneman is a GP in The Netherlands, Board Member of the Dutch Association of General Practitioners and Head of the Dutch Delegation of the European Union of General Practitioners (UEMO). The Dutch Association of General Practitioners paid for her travel expenses to the meeting. She has no other competing interests to declare.