White Coat Black Art26:30Primary care for all: Lessons from Denmark
Emily Ritchie wasn’t nervous about finding a doctor in Denmark.
She knew that within days of moving from Vancouver to her family’s new home in Copenhagen last year, they would be connected to a general practitioner.
Denmark residents are given a card with a number they use for everything from opening a bank account to accessing health care. The card also includes the name of an assigned general practitioner (GP), the equivalent of a family doctor in Denmark.
“You’re not left looking for a number. You’re not left searching for who to contact. It’s gold in a card,” Ritchie told Dr. Brian Goldman, host of CBC’s White Coat, Black Art.
It’s a stark difference from the situation in Canada, where finding a family doctor or nurse practitioner can be challenging. Some people can wait years depending on where they live.
As many as 6.5 million Canadians may be without a family doctor or nurse practitioner.
Dr. Tara Kiran, a family doctor in Toronto, says she knows primary care in Canada can be better.
That’s why she went to Denmark and the Netherlands to see how more than 95 per cent of the population in those countries have access to a primary-care provider. That’s much higher than the roughly 83 per cent of Canadian adults with access.
LISTEN | Primary care lessons: What the Netherlands can teach us
White Coat Black Art26:30Primary care lessons: What the Netherlands can teach us
Kiran says Canada can learn from these two nations’ around-the-clock access to primary care and use of primary-care teams.
“I really think it’s important that we raise the imagination around what is possible for everyone,” said Kiran, who also holds the Fidani chair in improvement and innovation at the University of Toronto.
There are many differences between Canada, Denmark, and the Netherlands, including how primary care is funded, how much its citizens are taxed, the health and demographics of each country’s population, how people are connected to a GP, and how physicians are trained and paid.
Yet, as Dr. Kathleen Ross, a family physician and past president of the Canadian Medical Association (CMA) wrote in a recent editorial, countries like Denmark “offer a glimpse of what’s possible” with their data sharing and team-based models.
Denmark, the Netherlands, Finland, Spain, and Sweden are often recognized for their robust primary care, says Dr. Toni Dedeu, senior advisor of integrated primary healthcare with the World Health Organization’s European region.
He says these countries rank high on factors like how well they address the population’s needs, the services they provide, and how their workforce is trained.
Team-based care is a key aspect found in all five of those countries, Dedeu says.
“At the primary health-care level, they can solve most of the conditions. This is because it’s not just a solo practice. It’s teamwork,” he said.
Connecting with a GP
In Denmark, all citizens have access to and a choice of a GP nearby. Danes can always change their doctor and see who is taking new patients online.
Kiran describes it as a “customer-oriented” system.
Caroline Bérard says it was a relief to connect with a doctor shortly after her move to Copenhagen last year. She had a family doctor in Montreal, but it often took weeks to get an appointment.
“It is very possible for Western countries to have a certain amount of doctors to accommodate a population. It’s not some far-fetched idea,” she said.
In Canada, the CMA says there aren’t enough family physicians for everyone. A December report from the Canadian Institute for Health Information (CIHI) shows the growth in the number of family physicians has slowed in recent years.
Denmark is not immune to that problem. That country needs to add about 1,500 GPs, according to Dr. Maria Krüger, a GP in Copenhagen and vice-chair of the Danish College of General Practitioners.
And in the Netherlands, an independent body tasked with auditing government spending is reviewing the impact of an aging population and staffing shortages on primary care.
Timely access
Being able to access a GP promptly is a feature of both Danish and Dutch health care.
In Denmark, most GPs have a few hours blocked each morning for patients with acute problems like pneumonia. Otherwise, people can usually get an appointment within five days, says Krüger.
That’s a stark difference from the weeks-long waits some Canadians face when they need to see their family doctor or nurse practitioner.
A 2023 Commonwealth Fund survey of adults in 10 high-income countries including Canada and the Netherlands found that only 26 per cent of Canadians surveyed can get a same- or next-day appointment. In the Netherlands, it was 54 per cent.
Family physicians in Canada are taking on fewer patients than they did before, according to CIHI.
That’s due to several factors, including patients with more complex needs, increased paperwork, and the need for work-life balance.
When Canadians can’t get a timely appointment, the alternatives can include virtual care services, walk-in clinics or the emergency department, where they can face long waits.
It’s uncommon to have a long ER wait in Denmark or the Netherlands, Kiran says. The Dutch call a regional number after clinics close. If a health issue can’t be handled on the phone, the patient is given an appointment at an in-person centre, says Dr. Angelique Heemskerk, a GP who works at one of the country’s after-hours call centres.
After-hours clinics and central phone numbers where people can speak with a nurse or physician exist in Canada. But Kiran says the Netherlands takes it one step further.
“It’s not just that they are speaking to someone on the phone like they might be able to at Health 811. They have this very sophisticated triage system virtually, but then it’s also connected to in-person care, which I think is really crucial,” Kiran said.
She adds that this system may not work for everyone, including those who don’t speak Dutch or English, and those who are homeless.
Team model
Kris Arts is a doctor assistant in a clinic in the Netherlands, a profession that’s a little different from physician assistants in Canada. She helps patients with a range of different health issues.
“I like that it’s very diverse,” she said.
Kiran says that many clinics have several physicians, maybe a doctor assistant, a midwife, and highly-trained nurses seeing patients.
She adds that establishing more team-based care in Canada could help with a family physician’s workload, because other health-care workers would handle things like routine preventative care and managing stable, chronic conditions.
“As family doctors, focus on the hard stuff and allow other people to come in and do this other work,” said Kiran.
WATCH | Publicly funded primary health-care ‘teams’ a priority, says CMA
The Canadian Medical Association (CMA) said in a new report released Tuesday that more Canadians should receive their main health care through teams of professionals so their increasingly complex needs can be met without paying privately for it.
Some provinces, like Alberta, Ontario and Quebec, already have primary-care teams, which can consist of nurse practitioners, pharmacists and physiotherapists, for example. The CMA is pushing for governments to create more.
Kiran says seeing how the Netherlands and Denmark offer patients around-the-clock care by a team of professionals in both countries has been eye-opening. She’s sharing what she found with doctors, leaders in health care, and Canadians through a forthcoming podcast called Primary Focus, which will discuss solutions to Canada’s primary-care issues.
“I would love members of the public to be even louder in their voices demanding change of the system.”
