The controversial topic of payment to see a GP seems like a good place to start writing today as it's one of the many contrasting aspects of Norwegian healthcare that I've been contemplating during my first few days in Frekhaug.
But before we get into that I'll go back to the beginning of my first day and how the adventure got going...
When it comes to generally navigating my way through a new place I've been fairly lucky up 'til now. Not only have I been in countries where information is relayed in English but I've been a little spoilt by the people I've been staying with; in Orkney being driven to work by my wonderful host John and at any moment of appearing lost being picked up by a passing neighbour, in California being kitted out with bike, helmet and comprehensive cycle route by my friend Hannah. Despite the excellent spoken English making conversation easy here in Bergen, the bus and boat timetables are quite another matter and I'm a little ashamed to say I was almost defeated by both.
As I stood in the damp early morning of Thursday having already seemingly missed two buses, one of which had not appeared at all, getting to my destination a mere 30km away seemed an impossibility. As I weighed up the risks/benefits of getting on a random bus in the hope it would take me roughly in the right direction I was rescued yet again by a kind driver who talked me through the changes necessary and set me on my way.
Being met by a smile and 'yes, I've heard about you' (a sentiment that has become very familiar over the course of the year) when I finally reached the health centre made up for the distinct sogginess I was experiencing and in the next few minutes I was delighted to meet Anne, my supervising GP for the month. After swapping so many e-mails in organising the placement, it felt great to put a face to the name.
The first thing on the agenda was to sort me out with 'uniform'. I was a little surprised to hear this and intrigued to find that all staff members in the practice wore a similar tunic, differing only in colour. As I was adorned in maroon, Anne commented that in the UK it seemed more important to 'dress pretty' whilst here it was preferred that people appeared equal. As a consequence I felt a little embarrassed standing there in my tweed skirt and cashmere sweater but at the same time found myself really enjoying the first example of Norwegian pride in their tradition of egalitarianism.
The health centre is relatively new and is aesthetically impressive with large spaces and lots of light; important in the darker winter days I can imagine. As a practice, it is fairly unique in that it is owned by the community and therefore the GPs and other workers are employed and paid a salary opposed to running a private business as is the case with most other Norwegian and indeed UK practices.
In a few days I've just touched the tip of the iceberg in terms of the differences but very quickly I'd say I've observed a calmer atmosphere and working environment to the one I'm used to. A large contributing factor to this is undoubtedly appointment length, twenty minutes which is typical for Norway, and patient numbers seen. We saw, on my first day, seven patients in the morning and seven in the afternoon freeing us up by about 3/3:30pm. There are obviously exceptions during 'on call' days and when people need to be seen urgently but predominantly this is an average day for many of the GPs. Slots are filled with either routine appointments or same day emergencies.
In Norway patients are assigned to one GP and it would seem that there is an element of patient choice in this process. Although this is the case in theory in the UK, in order to maintain reasonable access, patients often end up seeing another GP, either permanent or a Locum. This is frequently the root of complaints and concerns about lack of continuity in British General Practice. In Norway this is strongly discouraged; patients are obviously able to see another doctor in an emergency but in other circumstances are advised to wait. Because of this and patient list length, waiting times can inevitably be long; Anne mentioned it was on average a wait of 3-4 weeks to see her which she felt was really too long.
Whilst the continuity of seeing the same practitioner has been proven time and time again to be beneficial in improving patient experience, it is interesting to consider how that benefit might be offset by the inability to provide frequent follow up. This could be particularly problematic in the management of mental health and psychosocial problems when regular contact between doctor and patient can be a crucial and therapeutic in itself.
The Frekhaug practice serves a mostly young population which again makes it unusual in comparison to many UK surgeries. In a whole day clinic of eleven patients on my second day, ten were under the age of 45 and seven under the age of 20. This youthful demographic owes in part to the close vicinity of a community college as well as a large number of families who inhabit the area. I wondered how this low average patient age might affect expectations of the service, especially after hearing about the required payment for appointments.
Norwegians, as we do, fund social security (including health services) through taxes. However, they are also expected to make a small payment of 200 kroner, approximately 20 pounds, whenever they see a GP. This applies up to a certain amount in the region of 1500-2000 kroner after which consultations are 'free'.
Interested in this concept, especially in relation to ongoing concerns in our own country of how a payment would deter patients from seeking necessary help, I have, in the short time I've been here, made a point of asking people how they feel about it. Universally , of the people I've spoken to so far, all feel it is a necessary and fully justified part of healthcare. Then again, it is part of a system that they have grown up with and are used to.
I am fascinated, over the next few weeks, to explore how others feel about this question and in particular how such a concept might influence the prevalence of people presenting with mental health and psychosocial problems to their GP and how this might affect general wellbeing.