The municipality’s responsibility for the primary health service
‘You have stated that the white paper on primary health care lacks vision. What do you mean by this?
«The municipal councils feel little responsibility for either the GPs or the nursing homes. Things carry on in the same way, but no one tackles the problems that are slowly building up. We have not managed to fulfil the expectations raised by the Coordination Reform, and the newly established municipal 24-hour emergency units do not appear to be successful either. Do the local politicians actually know what is happening? Often the most newly qualified doctors are those who have responsibility for the sickest patients. Many of them have not even undergone the foundation programme before they are given sole responsibility for nursing home patients. Someone should feel a sense of urgency, but the Norwegian Association of Local and Regional Authorities and the municipal councils remain silent. So we cannot persuade Høie, the Health Minister, to speak out about the situation either,» she states, and continues:
«Quality work, competence enhancement and further education require a person to have time and resources; it can no longer be unpaid work performed in one’s leisure time. To achieve something better, it’s essential to invest. We must set equally high demands for diagnosis and treatment in the primary health service as in the hospitals, but base it on principles of general medicine. We also need better networks and increased systemisation in the primary health service.»
I venture to apply her method of asking a gentle but clear counter-question: «Might it be that you place responsibility on the municipal councils for matters that are actually beyond their control? Many people claim that regardless of how much you promote the recruitment of nursing home doctors, it will be difficult to motivate doctors to take these jobs as long as nursing home work does not qualify as a separate specialty. It was in fact the Norwegian Medical Association that originally voted against making it possible to take parts of the geriatric training in nursing homes, even though that is where the great majority of geriatric patients are.»
«Geriatrics is a specialist health service, and nursing home medicine is a primary health service. There needs to be a requirement for specialisation for nursing home doctors too, but based on a specialisation in general medicine with supplementary training in nursing home medicine. The municipal councils must make provisions for this type of specialisation.»
She points out that the Norwegian Medical Association has wanted a standard for staffing of nursing homes, and that all doctors should undergo a supervised foundation programme. ‘Høie has said that 2016 should be a year of implementation, and so the municipal councils should be busy following up the white paper on primary health care. We know from experience that they are far too good at putting things on hold.
She leans forward slightly and says: ‘I like the type of changes that we need here. They are not a matter of all-encompassing reforms, but small, manageable steps. Some municipal councils have already achieved a lot, while others should ask themselves what they can learn from them. Many people living in small municipalities are satisfied, and I ask myself whether proximity to the service is not the key word here. What has to be sacrificed in the quest for larger units?
The phone rings again. There is no sharp-tongued conflict now either – she conducts her conversation in a mild tone and ends with: «I can hear that you have done good preparatory work.» Is there a better way to inspire someone to further efforts?