General practice in Europe. A journey in comparisons.

Abstract

Since even before its introduction in 1948 our National Health Service has been subject to more criticism and comment (more unkind than kind) than any other of our national institutions. In all this the G.P. has come in for more than his share of abuse. It has been implied that standards in general practice have fallen, that many more patients are being referred to hospital, that practice premises are poor, and that many improvements are necessary. As a practising family doctor in our N.H.S. I have never been convinced by these criticisms and for a long time I have wanted to go and see for myself how our methods of general medical care compared with others considered to be the best. The opportunity came with a World Health Organization Fellowship in October, 1960. I was able to spend a week each in Holland, Denmark, and Sweden, visiting family doctors and watching them at work; seeing what medical services were available for the ordinary man in the street and his family, and what preventive care was going on to keep them healthy; and observing the inter-relations between the general practitioners and the hospitals and the social services. The Countries The medical services of a country must always be related to social, economic and historical backgrounds. Holland, Denmark, and Sweden were chosen because it was considered that they had many points of similarity with Britain. All had a Western European outlook and culture. Economically there were close ties with Britain and the basic standards of living were very similar. There were also natural differences. All were very much less densely populated. The population of Holland is nearly 11 million, that of Denmark is 41 million, and that of Sweden 72 million (compared with 50 million in U.K.). Compared with our area of 93,000 square miles, the area of Holland is 13,514 square miles, of Denmark it is 16,608 square miles, and Sweden is 173,436 square miles. All are industrial and agricultural countries, but nowhere is there any industrialization as intense as in Britain. Apart from a marked absence of atmospheric pollution, the climate in all three is similar to ours.