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 , ,8 95% Geriatrics39,7 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, % 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) ST-doctors in family medicine 33 ST-doctors in other specialities

The need for further ST-doctors To be fully manned in with actual resources (+ 50 %) 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 The needs with actual prerequisites % The needs with an aim at 1 GP/1500 inhabitants % The number ande needs for doctors in special training (ST) The actual number of ST1 850 The needs with actual prerequisites % The needs with an aim at 1 GP/1500 inhabitants %

The National board of Halth and Welfares prognosis about the number of specialist per inv – 2025 Allmänmedicin - 32 % Psykiatri - 28 % Internmedicin - 22 % Ortopedi - 19 % Kirurgi % Anestesi och intensivvård + 4 % Obstetrik och gynekologi +10 Samtliga specialistläkare + 18 % Källa: Socialstyrelsen, NPS-registret Prognosis

Costs and production in primary care Comparisons before and after the introduction of vårdval

International comparisons

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

…. drugs excluded

The relative cost of primary care and general practitioners in swedish counties and regions

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

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 The primary cares share of all visits to doctors has increased 10%

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 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!!