Continuity of care – the Norwegian experience

I Agree

Dear Editor

Denis Pereira Gray and colleagues argue that GPs should provide continuity of care despite the serious shortage of GPs.

Inspired by the UK general practice list system Norway introduced personal lists in 2001. According to the latest capitation report (November 2023) a typical general practice in Norway has four GPs working together. Median list size is 993 (1). According to a 2018 GP survey only a third of the doctors have clinical sessions every working day (2).

I used to work in an office with six GPs who each had clinical sessions 3 – 4 days a week. We recorded continuity for patients who had at least three visits during a four years’ period. Average SLICC (St. Leonard’s index of continuity of care) was slightly above 85 %. In another office a colleague with clinical sessions only two days a week achieved SLICC 75 %.

Patients who need follow up appointments usually get their next appointment at the end of the consultation with their personal GP. Patients who need a non-planned consultation when their own GP is absent, may be offered to see a colleague. But often they prefer to wait until their personal doctor is back. Most GPs have room in their schedule for such non-planned consultations. Thus, it is quite possible to provide excellent continuity, even when the patient’s personal GP isn’t present every working day.

Obviously, shortage of GPs is the major problem in the UK. It is hard to provide continuity when you must care for nearly twice as many patients as Norwegian GPs do. According to the latest capitation report only 3 % of Norwegian GPs have lists equal to or more than the average list size in the UK. These selected GPs are very experienced, having served in the same municipality for a median of 18 years (1).

Thus, it is possible to provide continuity even with large lists, but this probably requires experienced GPs who have cared for the same patients for many years. The challenge is how less experienced GPs, riddled by the demand for rapid access, may get their head above water to transform to stable, continuing care.

1. Patient adapted capitation [Pasienttilpasset basistilskudd].
2. The GP survey 2018. [Fastlegeundersøkelsen 2018].

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Electronic Publication Date: 
Saturday, November 18, 2023 – 17:14
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Continuity of care – the Norwegian experience

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Årstadveien 17, 5009 Bergen, Norway
Research Professor
NORCE Norwegian Research Centre
BMJ: Additional Article Info: 
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