Helena Legido-Quigley

Exploring the training and scope of practice of GPs in England, Germany and Spain

OBJECTIVEnTo explore general practitioner (GP) training, continuing professional development, scope of practice, ethical issues and challenges in the working environment in three European countries.nnnMETHODnQualitative study of 35 GPs from England, Germany and Spain working in urban primary care practices. Participants were recruited using convenience and snowball sampling techniques. Semi-structured interviews were recorded, transcribed and analysed by four independent researchers adopting a thematic approach.nnnRESULTSnEntrance to and length of GP training differ between the three countries, while continuing professional development is required in all three, although with different characteristics. Key variations in the scope of practice include whether there is a gatekeeping role, whether GPs work in multidisciplinary teams or singlehandedly, the existence of appraisal processes, and the balance between administrative and clinical tasks. However, similar challenges, including the need to adapt to an ageing population, end-of-life care, ethical dilemmas, the impact of austerity measures, limited time for patients and gaps in coordination between primary and secondary care are experienced by GPs in all three countries.nnnCONCLUSIONnPrimary health care variations have strong historical roots, derived from the different national experiences and the range of clinical services delivered by GPs. There is a need for an accessible source of information for GPs themselves and those responsible for safety and quality standards of the healthcare workforce. This paper maps out the current situation before Brexit is being implemented in the UK which could see many of the current EU arrangements and legislation to assure professional mobility between the UK and the rest of Europe dismantled.

Provider and service-user perspectives of volunteer health-worker service provision in Ayeyarwady Region, Myanmar: a qualitative study

Objectives To explore perspectives and reported experiences of service users, community providers and policymakers related to volunteer health-worker services provision in a rural area of Myanmar. Methods A qualitative interview study was conducted in rural communities with 54 service users and 17 community providers in Ayeyarwady Region, Myanmar, and with 14 national managers and policymakers in Yangon Myanmar. Topics included reasons for seeking health services, views and experiences, and comparison with experiences of other services. Data were analysed thematically using deductive and inductive coding. Results Accessibility and affordability were important to all participants. Service users described the particular relevance of trust, familiarity and acceptability in choosing a provider. Perceived quality and effectiveness were necessary for trust to develop. Perceived value of volunteers was a cross-cutting dimension, which was interpreted differently by different participants. Conclusions Results suggest that volunteers are appropriate and valued, and support ‘availability’, ‘accessibility’ and ‘acceptability’ as dimensions of health services access in this setting. However, social complexities should be considered to ensure effective service delivery. Further research into trust-building, developing quality perceptions and resulting service-user choices would be useful to inform effective policy and planning.

European retirement migration: access to health care and policy implications

There is a growing interest in European pensioners moving to other European Union Member States. Questions include how they adapt to their new country of residence, what are their motivations for migrating, what factors influence international retirement migration, and how can the various forms that this type of mobility takes be conceptualised? Yet there has been little research to inform these questions and, specifically, how pensioners access health care in their new country of residence. This chapter presents the European legal framework within which this group obtains health care. It then presents the findings of a qualitative study that explored the access to health care of British pensioners migrating to Spain. In this way it provides an understanding of the different pathways followed when accessing health care and how these chosen options were negotiated, including the factors that influenced the group’s decisions to choose either the public or private system. The chapter then presents a typology according to the type of care that this group decided to access. Following on from the findings of the study, the chapter concludes with policy recommendations that can help Europeans pensioners moving to another Member State.