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SWEDEN

In general

The newly established Institute of Family Medicine (IFM) (started on the 1^st of March this year) has going ahead on its attempt to stimulate and encourage CME among GPs (and other primary health care personnel like district nurses, physiotherapists, midwifes) and also to inspire research/developmental work and vocational training. In January next year the 1^st conference for Vocational Trainees will take place in Stockholm with the backing of IFM.

The first evaluation of the "Nationella handlingsplanen" (The National Action Plan - NHP) will be presented a General Practice meeting in December in Göteborg. The NHP stands for the support by the Swedish government on 9 billion SEK (Swedish crowns, equal to about 90 million Euros) from the year 2002 to 2004 to the primary health care. An increase in the number of GPs has priority. The shortage of GPs is the main obstacle for an efficient primary health care in Sweden.

In an other General Practice meeting in October in Göteborg (under auspices of The Swedish Association of Family Physicians - SFAM), the theme is Transcultural General Practice. In symposia, debates and free-standing papers focus will be on the complexity when patient and/or GP with different cultural background try to understand and communicate with each other in the consultation. Many immigrants from all over the world live in Göteborg, mainly in certain outskirts of the city. In sometimes 3 out of 5 consultations an interpreter is needed.

Quite recently we had an election in Sweden (no change in the Government - the labour party is still the dominating party) and one of the key issues in the pre-election debate was the big increase in the number of persons on sick-leave. The cost of sick listing is currently increasing at the rate of 25 million Swedish Crowns (about 2,5 million Euros) per day! The GPs have in the debate been blamed of being to free in giving sick certificates to the patients. The accusation has been rejected strongly by Meta Wiborgh, head of the SFAM. Major diagnosis are burnt out, depression and other "illnesses without diseases" and the arguments in the debate has been that too effective social forces create these symptoms.

Basic medical education

Primary care has in all universities been accepted as a necessary part of the undergraduate curriculum. Almost all schools are engaged in a change, usually including more involvement of GPs as teachers. In Göteborg for example, last autumn a new course (Early Professional Contact - EPC) started. It encompasses one week every semester in two years and the students are presented and introduced by a GP in the first clinical contact. The experiences are very positive so far.

Vocational training

There is still a great need of more trainee posts in general practice. According to the calculation by the Swedish Association of General Practice every second of all new trainee posts during the coming four years need to be established within general practice if the goal of 1 GP per 1. 500 inhabitants will be reached.

The goal-oriented approach of the vocational training seems to work out quite well. More and more of the GP spend less time in hospitals and longer period in general practice during the suggested 5 years.