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 8th Nordic Conference for University Hospitals and Faculty Deans (UHFD) 26 Aug, 2004, University of Turku

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

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

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 1.GP 2.GP  hospital 3.In hospital 4.Hospital  GP 5.Other interfaces GP Hosp

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

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

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

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 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 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 Thank you