Developing patient-centred health care is a political goal. However, knowledge of patients' preferences and needs is insufficient, particularly with regard to the GP service, and it is unclear how such information may be obtained.
The government white paper on primary health and care services describes the patients as the health service's most important change agents (1). The goal is for patients and their relatives to participate on a par with professionals and politicians in the efforts to achieve the changes necessary to build patient-centred health and care services.
General practice may be viewed as medicine's interface with society; however research and professional development in primary care have not been prioritised to the same extent as in secondary care. Knowledge of patient satisfaction is scant, and the association between user experience and quality of the GP service, and patient record data, is not used to any significant degree for quality improvement (2). No user surveys are systematically conducted, and there are no specific plans for gathering such information through the newly established municipal patient and user registry (KPR) (3).
Nor are healthcare personnel's experiences systematically gathered and used in quality development. This has now become clear, as the concern related to the regular GP scheme is on such a scale that many predict its imminent collapse if immediate measures are not taken (4, 5). This is a situation that probably could have been avoided if policy makers had more closely attended to what GPs actually do, asked more questions and evaluated the Regular GP Scheme on a continuous basis.
The basis for creating the patient's health service is therefore insufficient – knowledge of the users' and healthcare personnel's experiences is needed (6). Through The Commonwealth Fund's international health policy surveys, in which we have participated since 2009, satisfaction with primary care practices, the healthcare service for high-needs older adults and the healthcare service for the general adult population are scrutinised annually in a three-year cycle. In the evaluation in 2009, Norwegian users scored GPs' routines for quality measurement and quality assessment, coordination of services, availability and digital services lower compared to participants from other countries (7). In 2016, the survey showed that Norwegian patients had poorer experiences with their GP in the areas of communication, user involvement and consultation time compared to patients in ten other participating countries (8).
In the survey published in 2016, it was found that in the period from 2002 to 2015, there was a statistically significant decrease in participants who completely agreed with the question on whether the doctor takes 'me and my problems seriously' and more disagreed somewhat or completely (9). The survey also shows that in 2012, fewer had full confidence in the treatment provided than in 2002.
However, the results do not state what changes the patients would like to see or how this might come about, and they may be interpreted in different ways. For example, Norwegian patients could be more demanding than patients in other countries. The results may also be related to the fact that primary health care in Norway, and particularly the Regular GP Scheme, has not adapted to social changes and the new needs that these entail. In any case, we cannot rest easy with these results given that Norwegian primary care is aiming towards being among the best in the world.
However, the results do not state what changes the patients would like to see or how this might come about, and they can be interpreted in different ways. Could it be that Norwegian patients are more demanding than patients in other countries? It may also be the case that the primary healthcare service in Norway, and particularly the Regular GP Scheme, has not adapted to social changes and the new needs that these entail. In any case, we cannot rest easy with the results if we want the Norwegian primary healthcare service to be among the best in the world.
In light of the absence of patient-reported needs, the question of how user surveys should be conducted and how the results should contribute to development of the services is an important one. The Norwegian Knowledge Centre for the Health Services has developed a standardised method for measuring patients' experiences with the GP service at both local and broad level (called PasOpp), which constitutes a rational basis for collecting this type of data (10).
Nevertheless, use of pre-defined questionnaires does not provide answers to questions such as 'What is important for you?', a campaign launched in 2014 by the Norwegian Minister of Health and Care Services and the Norwegian Association of Local and Regional Authorities (KS) as part of the work of creating patient-centred care and to increase patient participation in their treatment. Evaluation of the responses to this question will place entirely different demands on resources with regard to collection and analysis of data. So why not establish a portal at municipal level, where patients and their relatives can record their views on the municipality's health and social care services?