1. gunnar.nemeth@capio.com 1 Seamless co-operation between GP and Hospital Staff – an utopia? Gunnar Németh, MD, PhD Professor of Orthopaedic Surgery, Karolinska Institute Director of Medical Development, Capio AB gunnar.nemeth@capio.com www.capio.comwww.ki.se 8th Nordic Conference for University Hospitals and Faculty Deans (UHFD) 26 Aug, 2004, University of Turku

2. gunnar.nemeth@capio.com 2 Why co-operation? Today there is a general scarcity of resources The patient needs one “general manager”, not be treated as a number of separate organs I would say that the GP is not a gate keeper. This is something repressive - hampering patients access to adequate treatment  it would be preferable if the GP has a holist approach, with a stewarding function, guiding the patient through the system – being his or her representative

3. gunnar.nemeth@capio.com 3 How? Focus on the different interfaces 1.GP 2.GP  hospital 3.In hospital 4.Hospital  GP 5.Other interfaces GP Hosp

4. gunnar.nemeth@capio.com 4 1. GP The general practitioner must be provided the resources needed –Sufficient time for patients –Colleagues to discuss and interact with –Collaboration with district nurses, PT:s, social insurance officers and psychologists –CME –Polyclinics – doctors from hospital having outpatient clinics on a regular base GP Hosp

5. gunnar.nemeth@capio.com 5 2. GP  Hospital Co-operation should be characterised by –Increased accuracy –More precise issues/questions in referrals –More involvement Resulting in –Decreased number of referrals –Less double work –Better results GP Hosp

6. gunnar.nemeth@capio.com 6 1.GP 2.GP  hospital 3.In hospital 4.Hospital  GP 5.Other interfaces GP Hosp

7. gunnar.nemeth@capio.com 7 3. In hospital Well defined responsibility –Investigation by hospital doctor or organ specialist is part of a more comprehensive care taking –The investigation should be Well adjusted Targeted –Respect in co-operation Avoid double work Do what is requested Close contact with referring doctor GP Hosp Consider safety and effective capacity for the patient

8. gunnar.nemeth@capio.com 8 3. In hospital, cont. Why not employ a GP in the hospital department? Broadens the scope for organ specialists A very good “communicator” with primary care Special circumstances – more needed – in surgical specialities –Admission visit before surgery –Increased co-morbidity among our elderly –Provides expertise to nurses GP Hosp

9. gunnar.nemeth@capio.com 9 4. Hospital  GP Always clear answers to issues on referral In general GP:s (in Sweden) appreciate a summary with a clear conclusion rather than copies of medical records “too undigested” Always send information to GP when a patient is discharged In cases of doubt – phone the GP or district nurse! GP Hosp

10. gunnar.nemeth@capio.com 10 5. Other interfaces Courses with joint faculties Shadowing colleagues –Outpatient clinics –In-hospital procedures Common activities, for example symposia with broad subjects covering both parties aspects of diagnostics and treatment GP Hosp

11. gunnar.nemeth@capio.com 11 Future … Several of the wonderful Finnish IT solutions we have heard of here today should be rolled out, e.g. -Shared knowledge base with common cases and principles for referrals -Electronic referral system -Shared electronic medical records -A web based system for reporting of adverse events (incidence reporting) -Associate practitioners and certify them for certain measures GP Hosp

12. gunnar.nemeth@capio.com 12 So… Is seamless co-operation between GP and Hospital an utopia? No! I think it is a possibility, gaining our patient and stimulating us

13. gunnar.nemeth@capio.com 13 Thank you