Box I.

Some facts about the Norwegian Regular GP Scheme.

• The Norwegian GP services system was reorganized in 2001 with the introduction of a patient list system.

• The Norwegian health authorities emphasized the importance of a continuous and personal GP–patient relationship when the new system was designed: “The object of the regular GP reform is to improve the quality of the services provided by general practitioners by making it possible for everyone who so wishes to have their own regular GP…. The reform will aim for continuity in doctor–patient relationships. This is particularly important in the case of people suffering from chronic diseases and mental illnesses, as well as the disabled and patients undergoing rehabilitation….”

• The GPs are allowed to set a limit to their list size, normally within the range of 500–2500. In 2009 the mean list size was 1181.

• When the GP list limit is reached, the list is closed for new patients, except for the children of list members.

• The patients have a free choice of GPs and are allowed to change to another GP list with free capacity twice a year.

• The “typical GP” works in the practice four days per week and in the municipal child health services or in nursing homes one day per week as a part of the GP contract. GPs with shorter lists normally work fewer days in their practices, often with larger part-time jobs within public health or universities.

• The GPs are given personal responsibility for the health services to the list patients within normal working hours on the agreed practice days by giving priority to the persons on the patient list before others. When absent, the GPs are obliged to have an agreement with other GPs to take care of the patients. Because 85% of GPs work in group practices, the colleagues in the same practice normally take this responsibility; alternatively, colleagues in the neighbourhood for GPs in single-handed practices. GPs have an extra fee for consultations with patients from other lists not included in this collegial collaborative agreement.

• The GPs also have the role of patient coordinators, including an expectation to participate in multidisciplinary cooperation

• The municipalities have the obligation to arrange after-hours health services, in which GPs normally take part.