1. Primary Care in the Czech Republic
Bohumil Seifert
Department of General Practice
1st Faculty of Medicine
Charles University in Prague
2017

2. Achievements on the journey back to Europe
Privatization of practices made general practice more attractive
Natural recruitment of people willing to work voluntarily for the discipline
Society of GP became one of the most influential body
Improvement of training for specialization
Establishment of Residency program, supported by state
Academic general practice development

3. General Practice in the Czech Republic
The point of the first medical contact within the health care system
GPs = private providers, have individual contracts with sick funds
List system
No gatekeeping function but people seek for care first by GP
Mixed reimbursement:
capitation + fee for service + bonus system

4. EUROPE MORTALITY (3/4 of all): Cardiovascular : 49% men 55% women
BASIC DEMOGRAPHIC DATA :
POPULATION ,5 MIL.
Unproductive <15, > ,4%
2006: births > deaths
Migration /year
Life expectancy : men 73
women 78,5
EUROPE
MORTALITY (3/4 of all):
Cardiovascular : 49% men
55% women
Oncological: % men
25% women

5. EUROPE PRIMARY CARE (96% private contractors) GPs 5200
(>15) average list pts/1GP
PC PEDIATRICIANS
(<19) average list 970 pts/1PCP
EUROPE
PRIMARY CARE
Ambulatory gyneacologists
Home care agencies on referral
24 hours
emergency services
Directly accessible specialists

6. Digestive and Liver Disease, 2008; doi:10.1016j.dld.2008.02.020
The typical general practice in the Czech Republic: SOLO PRACTICE
Seifert B, et al, The management of common gastrointestinal disorders in general practice.
Digestive and Liver Disease, 2008; doi: j.dld

7. Typical General Practice
Team: 1 doctor + 1 nurse
Facility: waiting room + nurse room + consultation room
Clinic: common acute problems, chronic patients follow up, systematic prevention, brief interventions, house calls, assessment medicine administration, social administration
Computers
Equipment: ECG, POCT LAB (CRP, coagulation control, glucometr), ORL examination devices
(Doppler, BP Holter, spirometry, rehabilitation devices)
Organization: open access / appointment system

8. Global problem: lack of GPs Policies and interventions in the CR
GP academic dpt. + GP Society + Government
improvement of pre-graduate curriculum:
best examples in training practices
information campaign about GP career
effective postgraduate training: shortened to 36 months
governmental support of residency program since 2008: 800 residents, 200 mil. EUR

9. GENERAL PRACTICE in the Czech Republic
….has to offer all attributes of medical speciality
for the full professional realization of physicians
Research
Teaching
Quality improvement
QUALITY
Continuous education
Good clinical practice
Postgraduate education
University
education
CONTINUOUS PROFESSIONAL DEVELOPMENT

10. University education 8 medical schools
All curricula include general practice
Not all have a chair in GP
Promising development in teaching and research
Few postgraduates students in general practice
BUT
Academic career in GOP rare
Low room in curriculum
PhD studies at the beginning

11. Prevention in general practice in the Czech Republic
STRENGTHS
System of preventive check up, extra paid prevention, population registered with GPs, screening programmes
WEAKNESSES
Low attendance of preventive check ups, low preventive culture in the country
OPPORTUNITIES
Increasing competence of GPs, role and position of GPs grows with preventive tasks
THREATS
Overload of GPs, expenses, interdisciplinary competition, overexamination, overtreatment

12. Prevention in General Practice
DEFINED CONTENT OF PREVENTIVE CHECK UP
(once in two years)
History
Physical examination
Lab tests, ECG
Cardiovascular and oncological risk assessment
(SCALE)
FOBT >50 every year/options in 55
Mammography (> 45-69, every 2years)
Cervic Cancer Screening (>20<65, every 3 years)

13. CME Many CME providers but Czech GP Society has a hegemonic role
Regional infrastructure with regional GP coordinators developed by GP Society
High attendance of CME: contacts with GPs a year
National conference twice a year (attendance > 1300 pts)
Society launches 4-6 practical guidelines every year

14. GP trainers/teachers Trainers for undergraduate teaching
Trainers for postgraduate training
Professors/teachers at academic departments
Lecturers for CME

15. Research Low awareness, low support Slow rising process Low financing
Research on quality assessment
Research on clinical epidemiology and management
Research on prevention

16. 2017