Summary
The EQuiP Case Report Interview identified recent policy developments in primary care in Norway. Nicolas Øyane highlighted the 2019 report emphasizing the need for more GPs and better quality of life for existing ones. The 'Future of GP Practice' aims to improve service quality, attract GPs, and promote team-based care. Norway faces challenges in implementing team-based care due to a lack of nurses and office spaces. Nicolas Øyane noted the importance of data, updated knowledge, and planning for quality improvement, criticizing the misuse of quality indicators. He also discussed the potential of e-consultations and the need for patient involvement in quality improvement initiatives.

Ulrik Bak Kirk:

Good morning, Nicholas. I will let you introduce yourself, but we have a very exciting interview happening here in a few minutes about the recent developments in Norway related to policy development about quality of primary care, about any quality related activities.

Nicolas Øyane:

Thank you. I'm Nicolas Øyane from Norway. I'm a GP specialist, I work part time as a GP in Bergen, and I'm also an Associate Professor at University of Bergen. I just started to work as a Medical Editor in something called the Norwegian Electronic Doctor's Handbook, giving decision support to GPs. For the last 10 years, previously, I've also been the CEO and and the Medical Director of SKIL, working with quality improvement in general practice. And I'm also the Norwegian delegate for EQuiP, which is very exciting. 

Ulrik Bak Kirk:

So, jumping into it, let's take it on the high level first: Has there been an important policy development about quality?

Nicolas Øyane:

Yes, it's actually very much happening in Norway right now, because for the last, yeah, probably 10 years, we had a especially a big report in nine, in 2019 it has been to get enough GPS. And I think everything is interconnected, right? You cannot start developing quality system or feedback systems. If you don't have any GPS, the GPS need to be rested. They need to have good quality of life, and that's that has been the problem. So without any GPS, you don't get anything else. You don't get quality improvement, you don't get patient treatment, you don't get GPS engaged in the community and and it has been also a change in the government during that period, right on the right side to the left side and that, but they have both focused on this. So in 2020 I joined the reference group of something called the future of GP practice, where there were three main aims. It was to improve the quality of the service or make it possible to do quality improvement work. It was also to get enough GPS into the system to make an attractive workplace, and the last was to be more team based, because and that's the important thing about Norway, which differs also from Denmark, is that in Norway, you almost only have GPS and health secretaries. And and you have about oh, point eight Health Secretary per GP. Usually. You don't have any nurses, you don't have any clinical pharmacologists or other people. You You have very little administrative staff, if you're not a very big office. So it has been some pilots trying out something called the primary health team, which is very interesting from a quality point of view, because when we measure our services, almost everybody is happy about the GP, we are rated really high, like the library is also rated really high. I think we're right above or right below. But there is one group that also doesn't respond to service, and that's the most vulnerable. For instance, elderly with multimorbid diseases, people with with the mixture of of of psychiatric disease, serious psychiatric disease and drug abuse, who cannot use the the they cannot just come to an appointment and get the tree. Comment and follow up. They need more complex. They need that we collaborate. So it's it's to improve the quality for these it's important to to collaborate more. And everybody agrees on that aim. However, they don't necessarily agree on how to do it right. And some people think that we should be we should build big teams in the doctor's office. We should bring in nurses, also feed your therapists and other people and make big centers. Some other people think we should use the electronic methods we have that we don't need to sit in the same place, but we need to speak together and maybe go through the home care nurses. There is a big concern about getting nurses into the GP offices, because the we lack a lot of nurses in Norway. So where do we take them from the hospitals? Is that okay? So there is lots of debate on how to do this and to take because that leg is probably the most interesting now, is that the teamwork also from a quality improvement point of view, it seems that the government, because next somebody will launch a new plan for the Future, and it's said to be a really big change, and so we are very anxious to see how will they manage that, and it might be what we called profession neutral payment that you can you can set up, for instance, a nurse or a psychologist To follow up some patients, and you will get the same pay. It's called professionals. And I don't know if you have that in Denmark or No,