The EURIPA Study Defining and describing rural practice “Making the case for rural practice”

WONCA study Funded by Wonca Europe Scoping study Across all of Europe EURIPA Listserver Problems Response rate Language/culture Size and complexity of questionnaire Quantitative/qualitative

Which Country do you practice in? Portugal 3 Turkey 2 Spain Finland 1 France Greece Hungary Romania Scotland Norway Italy Total 19

How is primary funded in your country?

Financial Do you have a state health service Is it insurance based 89% Is it insurance based 57% How do patients pay for services Free service 61% Nominal charge (return on justification) 19% Nominal set fee 14% Full cost 5%

Status of doctors in practice How many doctors work in your practice Average 4.6 (Range 1 to 16) Distribution of doctors by Gender Male 56% Female 44% Employment status Full time: Male 87.8% Female 87.2% Part time: Male 12.2% Female 12.8% Qualification in Family Medicine Male 53.2% Female 46.8% How many hours a day do you work on average? 6 hours (Range 6-14)

Status of staff How many qualified nurses work in the practice Average 3.7 (range 1-13) Do practice staff have any qualifications in any area of medicine to contribute to primary care Yes 47%

Population density % # Sig < 150 inhabitants/SqKM 47.4 9 5.3 1 > 150 inhabitants/SqKM 36.8 7 Sig > 150 inhabitants/SqKM 0.0 No comment 10.5 2 Total 100.0 19

Population served

Does the location of your practice affect the following?

Practice details What is your practice population 3720 (range 1200 to 17000) Average time spent with each patient 12.4 minutes (5 to 20 minutes) How soon are patients seen Same day 57.9 11 Next day 5.3 1 48 hours later No comment 26.3 5

Consultations, diagnostics and procedures How do patients arrange a consultation Appointments 80% Just turn up! 20% Can a patient have diagnostic tests and minor procedures conducted in the practice 78%

Outreach and specialities Does your practice provide a community mental health service 47% What outreach services are provided in your practice Psychiatry Paediatrics Gynaecology Physiotherapy Laboratory

Obstetrics

Computer records

IT Skills Are all staff who need to be computer literate? 58% Can your practice staff use IT to Access /update computer records from own desk 63% Link to diagnostic services Access specialist services 31%

Distance and travel How far is your practice from a district general hospital- 45 Km (Range 1 to 200 km)

Available transport for patients

Out of Hours Care Other forms of Out of Hours Cover: Local hospital Country rota Central town emergency service Local traige esrvice National call answering service (NHS 24)

Medication How are prescriptions paid for? Free 16% Patient 11% Subsidised 73%

Continuing Professional Development Is evidence of CPD necessary to continue in practice? 47% Are there any incentives for undertaking CPD? 36% Do you perceive a need for a rural postgraduate qualification in family medicine? 79% Would you undertake such training?

Public health Are preventative approaches to ill health explored in your practice 95% Do you follow a programme of illness reduction (WHO guidelines) 84% Do you have targets for some areas of medicine or disease improvement 58% Chronic conditions (diabetes, hypertension, COPD, CHD), terminal care, vaccination, anti-natal care adolescent abortions, communicable diseases, quality prescribing, use of diagnostic services. Rewards for achieving targets in some countries

Complaints Does your practice have a complaints procedure 74% Do you have a process for investigating critical incidents 47%