Programme no. 539-OP
Public Health
Retention and recruitment challenges in the Norwegian patient list system
Birgit Abelsen*1, Helen Brandstorp2, Margrete Gaski3
1Department of Community Medicine, UiT-The Arctic University of Norway,National Center for Rural Medicine,Tromsø,Norway, 2Department of Community Medicine, UiT-The Arctic University of Norway,National Center for Rural Medicine,Tromsø,Norway, 3Department of Community Medicine, UiT-The Arctic University of Norway,National Center for Rural Medicine,Tromsø,Norway
* = Presenting author
Objectives: We ask:
  1. What is the duration of GP-contracts, and how does the GP's gender and age, list size, and municipality size associate with duration?
  2. Which municipalities have the most severe challenges with assigning GPs to their patient lists, and how do they handle situations without regular GPs?
Background: In 2001, a patient list system was introduced in Norway, theoretically implying that all citizens are assigned to a general practitioner (GP). The GP contracts with a municipality. The system aims at securing continuity of doctor-patient relationships. This prerequisite is known to vary between municipalities, and the rural municipalities face the largest challenges.
Results: Municipalities with less than 2 000 inhabitants have retained less than 8 percent of the GPs entering the patient list system in May 2001, while municipalities with 50 000 inhabitants or more have retained 34 percent of their initial GPs. Nationally, 25 per cent of the initial GP-contracts where still functional in May 2014. Half of the GP-contracts in municipalities with less than 2 000 inhabitants had ceased after 2 years and 9 months. Corresponding figures for municipalities with 50 000 inhabitants or more was 9 years and 4 months.

The duration of a GP-contract increases significantly according to increasing municipality size and lists including less than 900 patients. The duration reduces significantly with increasing age, a female GP, or if the list includes more than 1200 patients.

The 2 981 GP-contracts terminated during the investigation period lasted on average 4.6 years, and varied on average between 3 years (< 2 000 inhabitants) and nearly 6 years (50 000 inhabitants or more).

Material/Methods: The material includes all 7 359 GP-contracts concluded between a GP and a municipality, in the period between May 2001 and May 2014. Each GP-contract is characterised by: the GPs’ age and gender, size of patient list, start and termination date (if reached), and the population size of the contracting municipality. The GP-contract duration is measured as the time from conclusion until terminated (or censored at end of follow up), and is analyzed using survival analysis (Kaplan-Meyer survival curves and Cox regression).

The same period, 1 091 patient lists were not tied to a named GP. To investigate further into this, a supplementing survey will be conducted in January 2015, to provide better insight into the use of GP-substitutes to serve such lists in rural municipalities. Survey results will be included in the presentation.

Conclusion: The difference in the duration of GP-contracts between large and small municipalities will increase. Assuming that continuity in the doctor-patient relationship provides better service quality, these results suggest that patients in small municipalities are offered less service quality than patients in large municipalities.
Points for discussion: Is this situation acceptable?