Evaluation of vårdval in primary care Swedish medical association

• Survey of manning in primary care 2013

• Report about funding and economy in primary care 2014

• Report about the external conditions in special training 2014

• Inquiry to all members of the Swedish union of general practitioners 2015

Survey of manning nov 2012

Swedish Medical Association

Results- number of different specialists in primary care, calculated as full time employees

Fasta Längre vik Totalt %

Family medicin 3 888 651,9 4 539,8 95%

Geriatrics 39,7 8,3 48 1%

Pediatricians 30,6 4,6 35,1 1%

Gynecologists 10,5 0,8 11,3 0%

Other specialists 105,4 44,6 150 4%

Summary 4 074,1 710,1 4784,3 100 % 8 procent were 65 year or older

Vacancies

– primary care units (PCU) have the need and

economy for employing more GPs

• 858 full time GPs

•41 % of all PCUs (50 % off all public and 28 % of all private PCUs)

”Rental doctors ”

- in Swedish primary care

Number of listed patients/GP in all counties and regions

Percentage private GPs in all counties and regions.

Percentage PCUs who can afford and need to emply a GP

The situation on special training (ST)

1 863 ST-doctors in family medicine

33 ST-doctors in other specialities

The need for further ST-doctors

To be fully manned in 2017

+ 958 with actual resources (+ 50 %)+ 1 679 to be 1 GP/1500 inhabitants (+ 90 %)

61 % of PCUs needs more ST-doctors 31 % are in balance 8 % have more ST-doctors than their actual need

Overall results from november 2012 The number and needs for specialists in family medicine

Total number including substitutes 4 800 The needs with actual prerequisites 5 700 + 20 %The needs with an aim at 1 GP/1500 inhabitants 6 200 + 30 %

The number ande needs for doctors in special training (ST)

The actual number of ST 1 850 The needs with actual prerequisites 2 800 + 50 % The needs with an aim at 1 GP/1500 inhabitants 3 500 + 90 %

The National board of Halth and Welfares prognosis about the number of specialist per 100 000 inv. 2008 – 2025 Allmänmedicin - 32 %

Psykiatri - 28 %

Internmedicin - 22 %

Ortopedi - 19 %

Kirurgi + - 0 %

Anestesi och intensivvård + 4 %

Obstetrik och gynekologi +10

Samtliga specialistläkare + 18 %

Källa: Socialstyrelsen, NPS-registret

Prognosis

Degree of employment of doctors in regions and counties

0

10

20

30

40

50

60

70

80

Allmänläkare Andra specialister Överläkare Under 49 % 50 - 74 % 75 - 89 % 90 - 99 % 100%

20 %

73 %70 %

Costs and production in primary care

Comparisons before and after the introduction of vårdval

International

comparisons

Proprtion of population with a permanent GP 2013

0 20 40 60 80 100 120

Sverige

Storbritannien

Nederländerna

Tyskland

Norge

Schweiz

Frankrike

Sweden has a peculiar organisation of care compared to other OECD-nations 1 - Least number of visit to the doctor/inhabitant

2 - Almost most doctors/population

3 - Least number of patientvisits/ doctor

4 - Least share of GPS in OECD

5 - Least share of patients with a personal GP

6 Least number of hospital beds/inhabitant

Results of Swedish health care

Good results but very poor in coordination and continuity

The change of costs of different sectors of Swedish health system

2001-2012

…. drugs excluded

The relative cost of primary care and general practitioners inswedish counties and regions

Allmänläkarvårdens andel av hälso- och sjukvårdens nettokostnader

4,5

5,76,2

6,9

7,77,9

8,88,88,9

9,59,7

10,1

10,310,410,5

10,510,6

10,710,710,7

11,513,2

0 2 4 6 8 10 12 14

Dalarna

GotlandKronoberg

Jämtland

Örebro VästerbottenÖstergötland

BlekingeVärmland

Skåne

StockholmTotalt

JönköpingSörmland

Västernorrland

GävleborgNorrbotten

Halland

Kalmar Västmanland

Uppsala

Västra Götaland

The relative change of number of visits to doctors in different

healthcare sectors/year

The relative change of the number of visits to a GP/inhabitant 2002-2012

Conclusions

1. Sweden has very few visits to doctors/population , low share of primary care practitioners and relatively low ratio of patients with a permanant doctor in primary care

2. Primary care has increased its role in urban areas hads decreased its role in rural parts in the north.

3. The costs for general practitioners and nurses has increased since 2000

4. The primary cares share of all visits to doctors has increased 10% 2001-2012

Survey on ST in family medicin

-an analysis of recruiting and planning and thoughts about how to increase the dimensioning

Survey adressed to swedish directors of studies in family medicin Questions

•How do your region plan, dimension and recruit doctors for spescialist training in family medicin?•Are there any analysis concerning future needs (planning and dimensioning)? •What is the role of PCUS in planning??•Who is responsible for recruiting ?•Funding??

Survey of number of ST 2013.

- Has it changed since the 2012 survey ??

Planning, dimensioning and analysis of future need

• Most counties have some kind of coordination concerning planning and dimensioning – but with great variations

• Most counties have some kind of unqualified analysis

• Most counties have no central coordination of planning, recruiting,recruiting and analysis

Focus group results

Factors of success

•Family medicn and primary care gives a possibility to combine family life on equal footings and professional development •Continuity and the personal relation

Factors to change•Monotonous and high workload•Communication and coordination with specialized care.•Indistinct decisionmakers. •The negative trademark

Propositions- on three levels

1.National: Coordination, stimulance and follow-up

2. Regional: Development of structures for dimensioning, planning , recruiting and funding ST in family medicin

3. Local: Regionally certified PCUs for supervising ST. Extra reimbursement for certified PCUs

Conclusions of all reports

1. Increeasing regional unequalities

2. Primary care poorly financed

3. Increased need for more ST-doctors in family medicin now!!