Improving Rural Quality and Continuity of Care. the Senja Doctor Project

Improving rural quality and continuity of care. The Senja doctor project

Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 929

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Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Key elements in the Norwegian health care system y The state is responsible for specialized health care y The municipalities are responsible for primary health care

y Norway has 430 municipalities (4 858 200 inhabitants 01.01.2010)

y 50 % of the municipalities have less than 5 000 inhabitants

y Most of the small municipalities are located in rural areas

Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Photo: Svein Steinert Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Photo: Svein Steinert Population 1.1.2000 1.1.2010 Change Berg 1119 929 -16,6% Lenvik 11018 11258 +1,8% Torsken 1171 908 -22,9% Tranøy 1684 1527 -8,4%

Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Age 67-79 % 80-89 % 90+ % Berg 12,5 5,5 1,8 Torsken 13,1 5,6 0,8 Tranøy 13,5 6,1 1,3 Lenvik 9,1 4,3 0,5 County of 8,2 3,5 0,6 Troms

Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Quality of service

Within a 10 year period we had 73 different GPs in the municipality of Torsken.

Hans Peder Pedersen, former mayor.

Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Expenses

Municipality Expenses GP service 2007/inhabitant

Berg 308€ Lenvik 128€ Torsken 276€ Tranøy 209€

Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Previous recruiting actions y Wage y Subsidized rent y Redused work time – driving included in work time y 1 day home work/week

Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Then in 2007.. The mayor of Torsken makes a request to the mayor of Lenvik: ”We can not deliver a GP service of sufficient quality and stability, we need help and we want to be part of an intermunicipal GP service.”

A project group with administrators and a doctor was established.

31.8.2010 the Senja doctor project was officially started

Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Content and principles of the Senja Doctor y Establishing a main office where all doctors meet at least one day/week y All doctors is part of a professional network y Fixed wage y Not more than 2 days/week on remote local offices y No doctor serves more than one remote local office y Driving to local offices is included in working time y Reduced length of list y Organized for scientific activity y Organized for internists and registrars y No public health responsibilities

Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Local office, Skaland

Local office, Gryllefjord

Local office, Sifjord Main office, Silsand

Karsten Kehlet, National Centre of Rural Local office, Stonglandseidet Medicine. Palma 14.5.2010 Main factors essential for the establishing og The Senja doctor project. y Political will both locally and centrally y Administrative understanding and dynamic y Professional involvement y Involving essential external partners. (National Center of rural Medicine, Chief medical County Officer and County Governor) y All parts are aware that this project is not a money-saving project.

Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Criteria of success y Staff stability y Quality of service y Research y Economy

Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Challenges y Intermunicipal cooperation is a fragile matter y Economy y Competence y Stability of other health personell y Understanding and acceptance of the project

Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010 Thank you for your attention

Karsten Kehlet, National Centre of Rural Medicine. Palma 14.5.2010