Models of the out-of-hours care

- European experiences

Paul Giesen (Netherlands)

Morten Bondo Christensen (Denmark)

Janko Kersnik (Slovenia)

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1. Introduction, aims and program

aim:Providing information on the different organisation models of out-of-hours care in some European countries.Reflection on the benefits and the disadvantages of the different models and the

position of de GP’s in future. To chose the organisation model preferred.

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2. Out-of-hours primary care services throughout Europe

Paul Giesenoverview what are different organisation forms in Europewhat are the general problems

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3. Three different organisation models of out of hours care

Danish solution by Morten Bondo Christensen (Denmark)Slovenian system by Janko Kersnik (Slovenia)Dutch solution by Paul Giesen (The Netherlands)

Danish solution

Morten Bondo Christensen, Denmark

Slovenian system

Janko Kersnik, Slovenia

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The ice berg of health care

HOSPITATLISED

SPECIALIST TREATMENT

PRIMARY CARE

SELF-TREATMENT

ILL

HOSPITATLISED

SPECIALIST TREATMENT

PRIMARY CARE

SELF-TREATMENT

ILL

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The concept of FM/GP

First contact…

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The practice of the first contact

Regular hours– Emergency care– Outside the GP/FP area– Holidays

Out of hours– Emergency care– Usual primary care– Outside the GP/FP area

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Principles

24-hours responsibilitycatchment area (15 – 30.000 population)network of appointed institutions (community based)rota system/deputising services (each doctor with patients on the list has to paritcipate)first contact (each patient needs a referral)

primary care emergency services doctors

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Strength

Primary care concept in placeBetter accessibilityBetter availabilityPersonalised

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Weaknesses

Lack of human resourcesCost effectiveness?Involvement in serious emergenciesCheck point? (PHC, hospital, patients’ homes…)

Dutch solution

Paul Giesen, Netherlands

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4. Reflection to your own out-of- hours care system: What is the strong and weak side and what would be ideal?

Discuss with your neighbour {from other country, if possible} (5 min) on the following questions: structure of the organisation (scale, management), distances to the doctor,doctor: workload, satisfaction with work personal and material supportwho does the triageposition and cooperation in emergency care (GP/hospital/ambulance)benefits and disadvantages of the model

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Lessons to learn

Reports from the groups:

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4b. What would be ideal - with reflection to your own system

1. organisation of out of hours care:

A. hospital/ambulance care, no duty for a GP B. I am always on duty my ownC. small rota’s (groups <10 PG and <20.000

patients)D. large scales co-operatives (groups > 50 GP

and > 100.000 patients

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4b. What would be ideal - with reflection to your own system

2. What kind of doctors should do the out of hours work?

A. GP’sB. specialised GPsC. all doctors can do it

3. Triage

A. myselfB. my wife/relativesC. nurses/ call

centre

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4b. What would be ideal - with reflection to your own system

4. In case of emergency

A. I am the first responder

B. Patient ring ambulance or go to hospital

C. I cooperate with hospital/ambulance and divide tasks

5. demands of patientsA. I accept all demands B. I accept just urgent

demandsC. I accept all demands

but discourage non-urgent demand

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Conclusions

We poses the skills to deliver primary care in a patient oriented way.There should be systems in place to help reduce the burden of workload.There should be a sound division of work between emergency care services and GP/FM services in line with the needs of the local/regional populations.

Thank you for your attention!