In the US, the federal government and a large number of the country’s general practitioners (GPs) favour the Dutch model of providing after-hours primary care.

This is the conclusion of an editorial written by US experts David Margolius and Thomas Bodenheimer in the July issue of the prominent medical journal Annals of Internal Medicine (AIM).

The editorial was based on a review of after-hours primary care in the Netherlands by Paul Giesen, Marleen Smits, Linda Huibers, Richard Grol and Michel Wensing of the Radboud University in Nijmegen. Their review was published in the same issue of AIM.

Centre stage in the Dutch approach is taken by GP cooperatives staffed by GPs who, in addition to their own practice, provide after-hours primary care together with trained triage nurses. The main advantage to the system is that, by and large, the same quality of primary care is provided across the Netherlands.

Contactability
Paul Giesen, one of the authors of the article Quality of After-Hours Primary Care in the Netherlands: A Narrative Review, describes the Dutch system of GP cooperatives as “uniform and effective.”

“On top of which, all GPs participate. And that is a major difference with the situation in the United States, where just 30 percent of GPs provide after-hours primary care. This means that large numbers of people automatically turn to hospital emergency departments for assistance, which is much more expensive.”

Another advantage of the Dutch system of GP cooperatives is their contactability and the presence of trained triage nurses, who can answer patients’ initial questions and so avoid placing an unnecessary burden on the GP.

“Many people who are worried, or simply want to ask some questions can be reassured by telephone. All they really want is simply talk to an aid worker who can give them advice.”

Want to be free
The US federal government would like to introduce the Dutch model, but US GPs are still divided on the issue.

“Many GPs are saying ‘we should adopt the Dutch system.’ Look for instance at the authors of the article. However, there is also opposition, GPs who say ‘I just want to be free, and do what I feel like doing as a professional and a GP. I have nothing to do with the government.’”

• Read more 

Development of Out-of-Hours Primary Care by General Practitioners in The Netherlands
(pdf; external link)

(gsh/rk)