Report on Dutch Visit (Romford VTS)

Report on Dutch Visit

I would like to start by expressing my thanks to all our Dutch colleagues who made us so welcome.

We arrived early on Wednesday morning - having reached Stansted by 5 am. The loss of the hour meant that we arrived in Schippol for 9.10. With only a minor blip - one of the programme directors and a registrar went missing - we were finally ready to be whisked off to the University of Amsterdam at about 9.45am

On arrival we were greeted by one of the course organisers Jacqueline Bloemen who made us feel instantly at home

The morning consisted of an overview of Dutch General Practice - by Prof. Dr. Margreet Wieringa - outlining the main structure of practice and training.

This was followed by presentations of audits from the registrars in practice focussing on areas within the practice which could be improved. Examples of this included inhaled corticosteroid prescribing in asthma, routine gp visiting for patients in hospital and post hospital , stop smoking protocols and dementia care

Obervations on GP training

3 years - First and last spent in primary care
17 nights per year
2 exams per year but only have to pass one
Whole day release course
High level of satisfaction
No gate in. No gate out. Annual end of year assessments
Matching with trainers like our VTS with the right of a single veto for the registrar
There are 70 registrars in the scheme which covers half of Amsterdam

Observations on Dutch General Practice

Average list size 3000
Consultation rate 2.8
Less target and protocol driven than UK
More visits than UK - about 12 per week for 3000 patients
Less staff - in the practice observed only 3 employed staff and usually only one present at a time
A nurse would work in reception and also as the practice manager
Childhood immunizations are done elsewhere
Yellow fever and other vaccinations are done elsewhere
Sickness certificates are not issued by GP's
Antenatal care done at a special centre
Much smaller waiting areas suggest less pressure on space than in the UK
Incomes are lower but quality of life seems higher
Many UK registrars observed how ' nice ' the Dutch patients were reflecting the excellent rapport with their doctors
Approaching 70 percent female GP's in training now

We then moved for the afternoon to some formal lectures from Dr. B. Wanrooij a gp expert in palliative care looking at end of life sedation, which was followed by a presentation from one of our registrars Zulfi Thebo on the UK situation. Zulfi has recently completed a hospice post in his rotation and was well qualified to review the current state in Britain.

We then had an insight on the practice and rules regarding euthansia by Prof. dr. D. Willems.

Armed with this new knowledge we broke into small groups to discuss various cases and focus on the ethical aspects.

In the evening we were treated to a wonderful meal in a waterside venue by our Dutch hosts and had the opportunity to meet with Dr Kees van der Post who had organised our visit so expertly.

The next day we visited practices on an individual basis and had the priviledge of sitting in on 2 surgeries and going on visits. During this I experienced first hand a patient with terminal COPD being counselled about euthanasia by his doctor.

Following these visits we met as a group to reflect on our experiences

Observations on euthanasia

About 1/1000 per year in practice observed
Criteria - persistent request, unbearable suffering
Process

Councelling
Formal application by patient with form filling
2nd doctor - independant ී; scan doctorී; reviews
If all in agreement procede - sedation and curare

Can be done for any condition not just malignancy - eg end stage COPD.
Most Dutch people I talked to [ 7 non medical ] all felt that it was a good idea and were shocked that nothing similar was done in UK
Not all of the doctors were comfortable with performing euthanasia
There is some variance amongst practitioners on which cases are acceptable

Romford VTS

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