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A brief review of the organisation of General Practice in the Netherlands
In Holland the General Practitioner (GP) is the pivot of the primary
health care. In the Basic job Description is defined that the access to
the GP must be "immediate, free and permanent". That means,
that a GP must be able to see a patient (if necessary in case of emergency)
within 15 minutes. Free refers to access without obstacles and by permanent
is meant 24 hours a day and 7 days a week. The GP's form groups in their
environment with one of them on duty outside office hours to provide this
service.
Besides the care for physical and mental health of patients the GP is
involved in prevention programmes like flu vaccinations and Pap-smear
investigation.
The GP forms a "gate" for the patients to the specialists in
the hospital. Everyone has first to see the GP before going to the hospital.
There are about 7000 GP's in the Netherlands. They work in about 4800
practices, 650 practices have also a pharmacy function. The average number
of patients by one GP is 2350. Most of the GP's (77%) work in a solo practice,
22% in duo practice and 7% in a Health Centre. These numbers
were published in 1994, the trend is that more GP's work in a health centre
and less as a soloist.
There are 8 universities in the Netherlands where you can study to become
a GP. Every year there are 280 GP's who finish their education. Since
1994 the study takes 3 years.
1st year: the trainee works 4 days a week in a GP practice and visits
I day a week the university. In the practice he/she learns the most frequent
problems in GP practice (especially those who cover a short episode).
Also the most frequent chronic problems like diabetes and hypertension
get attention. During this year the trainee can explore how he/she want
to function as a gp.
2nd year: the trainee works in several institutions outside the practice
like a nursing home or psychiatric hospital. Again one day a week there
is education at the university.
3rd year: the trainee works 4 days a week in a practice
(different from the first one) with emphasis on practice management and
management of chronic diseases. By now the trainee should be ready for
the profession of GP. One day a week university education.
Country coordinator for the Netherlands:
Lucie Podzimek
AMC/University of Amsterdam
Department of Public Health
Meibergdreef 15
I 105 AZ Amsterdam, The Netherlands.
Telephone:+31 20 566 71 76
Email: l.podzimek@amc.uva.nl
Netherlands - HOST PRACTICE
A.F.E. Bots, huisarts
Hintliamereinde 13
5211 PL 's-Hertogenbosch
telephone: +31 73 6134450
private: +31 73 6123405
fax:+31 73 6146260
e-mail: a.f.e.bots@home.nl
Hello, my name is Lex Bots.
I am general practitioner since October 1983 in 's-Hertogenbosch. I am
the only general practitioner in my practice. This practice is located
in the same house as we live in. It is an old house (built in 1899). In
a way it is a rather old fashioned way to work arid live in the same house.
But fortunately all the modern requirements are available. The whole administration
is computerized.
It is a big practice (> 3000 patients) with 11%) children and 12.5%
elderly people. A few of them are living in an old people's home. if you
look at the population of the Netherlands, it is an average of that population.
The location of the practice, in the house, means that the whole family
is involved in the practice. The location, in the centre of the city of
's-Hertogenbosch (in the middle of the Netherlands, 87 km from Amsterdam,
128.000 inhabitants) gives a lot of pleasure for all of us. We are near
cinemas, theaters and a lot of pubs, restaurants and museums.
My wife, Lili, is, as a kind of manager, involved with the financial administration,
the computer processing of the medical files and the daily routine. There
is also a practice assistant; she is in charge of the medical administration
and she takes care of the first contact with the patients. All the telephone
calls will be judged by her.
Once a week there is a diabetic nurse, especially for the control of the
diabetic patients. The contacts with the specialists in the local hospitals
(2 hospitals with 725 and 363 beds) are perfect, there is a good cooperation
Besides ordinary daily duties, I often participate in medical studies
by pharmaceutical order. Hypertension, pulmonary diseases and gastro-entorology
are topics.
Furthermore I am in the board of the local doctors association and I am
involved with the medical education of future doctors in association with
the university of Amsterdam.
We have 2 children, Sophie of 14 years and David of 12 years old.
There is a possibility to stay in our house (a room will be available)
during your stay in 's-Hertogenbosch; except during our holidays.
We look forward to meeting you.
Netherlands - HOST PRACTICE
PP. van de Vijver
R. van de Vijver - Fesevur, huisartsen
Worinerplcin 63
1442 CC Purmerend
The Netherlands
tel +31 299 431131/431481
fax +31 299 431541
e-mail viivfes@kning.nl
HUISARTSENPRAKTIJK WORMERPLEIN
Our practice is situated in a city of about 70.000 inhabitants.
Together with 15 other practices we form a so-called "Hagro",
which means a group of practices that tries to work together in several
aspects:
24 hours on-duty, arrangements with the local hospital and other professionals
in primary care.
The city of Purmerend is located about 15 km north of Amsterdam and is
accessible by road, bus and train. The airport of Amsterdam (Schiphol)
is about half an hour by car. Purmerend has a small centre with old houses;
the major part of the city was build after 1960 and is still growing.
Many of the inhabitants are working in Amsterdam, the city in which most
of them or their parents used to live before they moved to Purmerend.
Our practice consists of 2 family doctors, l trainee and 2 assistants
for 3300 patients. The trainee is a medical doctor specializing in General
Practice. In this regard our practice is affiliated with the University
of Amsterdam (department "huisartsgeneeskunde"). We are both
working part-time, letting the trainee enough space to do the surgery
himself. One of us is co-ordinator of post-academic training for GP's
in the region.
One of the most attractive aspects of working in Purmerend is that the
city itself has a reasonable scale and on the other hand has the advantages
of a big city nearby. In terms of medical care we have in fact only one
hospital we refer patients to; we know all of the specialists personally,
which makes the lines short. Furthermore we have intensive contact with
all the members of the "Hagro" and evaluate the patients seen
when on-call. We have regular meetings with other workers in primary care
such as the physiotherapists and a social worker.
A hot item between GP's at the moment is how to diminish the workload.
One way to do this is to delegate more of the work to the assistants in
the practice and to make use of practice nurses.
The most important thing, however, is to keep a good humor and fun in
the work we're doing. Being a host to a medical doctor specializing in
General Practice from abroad is a part of this.
Netherlands - HOST PRACTICE
Jeroen van der Lugt en Katla Kuschbert, huisartsen
Edamstraat 61, 1507 JB Zaandam, The Netherlands
Telephone +31 - 75 - 6170185. Fax +31 - 75 - 6157837
E-mail 1ugtk~s@knmg.nl
Dual-surgery of general practitioners
At 22 minutes from Amsterdam Central Station (12 minutes by train
and 10 minutes walking) our practice is located in a recently built area
of the historically well-known town of Zaandam. Czar Peter the Great of
Russia learnt how to build ships here in the 18th century.
We are two part-time working general practitioners, 43 and 36 years of
age. Next to being partners in practice we are also partners in life.
We have two children 4 and 2 years of age. We employ in our practice three
assistants (Astrid, Addy and Linda) all working part-time. Every year
a trainee-general practitioner works with a lot of own responsibility
in our practice. This year Ilona Bolt is our trainee. Our trainees are
in education at the Academic Medical Center in Amsterdam.
The practice consists of approximately 3300 patients, mainly families
with young children. The part of the town we work in was built 10-15 years
ago.
We speak Dutch to our patients, who we see on appointments planned for
10 minutes each. Translating the conversations into another language will
not always be possible. We all speak English and German, some of us also
French and a little Spanish.
Our practice is a convenient place to observe the way GPS in Holland work
and to get an idea of communicating with other health care workers outside
and inside the hospital.
We look forward to seeing a colleague of our trainee Ilona once or twice
a year in our practice. Autumn will not be convenient to us, the rest
of the year we will be able to receive a guest trainee.
Netherlands - HOST PRACTICE
Practice Jacobs
Contact person: Han Jacobs, GP
Address:Italielaan 170
2034 BZ Haarlem
+31 23 533 15 92 (office)
+31 23 533 76 53 (home)
+31 23 533 06 12
Email: jwjacobs@knmg.nl
The practice is situated in a modern suburb of the city of Haarlem called
Schalkwijk, nearby a hospital Kennemergasthuis.
There is one full time working GP with one assistant who works part time
(every morning) and a trainee family practice in collaboration with University
of Amsterdam.
The practice counts 2750 patients, 15V() older than 65 years, 30% allochtones
I am chairman of the District of Family Doctors Organisation. I speak
Dutch, German, English, some French and a little Russian.
There is no preferred period of visit, but 1 do not have possibilities
for accommodation. Nearby is a Van der Valk Hotel (Haarlem south).
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