Her Royal Highness Crown Princess Mary, Patron of Healthcare Denmark
Primary care systems vary widely in economically advanced societies around the globe. The Danish system is often touted as primary care done right. So what are the key features of the Danish general practice?


Like most western European countries Denmark has a national health service that covers the entire population and is free for all to attend. Most specialists are hospital based employees but general practitioners operate as small businesses, usually in one or two man practices. Every two years they negotiate a contract with the local health service for the primary care management of their patients. The contract states that they are responsible for the care of at least 1600 people but once this number is reached they may close their books to new patients. The contract provides more than 95% of a GP's income. 
Patients can choose any registered GP as their local doctor, if her books are open, and can optionally register on that GP's "list". This is not a requirement but it is financially advantageous to do so and 98% of the population nominates a GP for their routine care. Patients can change GPs but only once every three months. 

Davos, in the Swiss Alps
Each year the world's leaders in business, economics, politics and technology meet in the remote Swiss town of Davos in the depths of winter. They are not there for the skiing, but to contemplate what future worlds might be like. 
The World Economic Forum founder, Professor, Klaus Schwab, believes the world is entering the Fourth Industrial Revolution where the integration of digital, physical and biological technologies has a disruptive effect on society and government which will be at least as significant as the three industrial revolutions that preceded it. 
"The future is already here. It is just not very evenly distributed", wrote science fiction writer William Gibson in 1993. He is correct. 
On 12 July 1956 Dr John Sullivan reported on his first test result from his new rooms in a cottage on Wickham Terrace. Eighteen months later he was joined by Dr Nicolas Nicolaides. Sixty years later Sullivan and Nicolaides Pathology is now one of the largest pathology groups in Australia.

Dr Andrew Binns with GP registrar Dr Noah Verderio

GP1 registrars are beginning their first term in general practice training. While some will have had experience in the GP setting during their student years, a greater number will have been engaged predominantly in hospital training and had relatively little exposure to the GP environment.

Feedback indicates that transitioning from RMO placement in the supportive hospital environment, characterized by ample resources such as medical specialist skills and technology, to the primary care setting can be daunting. The registrars need to be more self-reliant on clinical skills and on developing an ability to understand a patient’s psychosocial background, family history and lifestyle practices.

Consider the difference between working in an emergency department and a general practice. In ED the requirement, often under significant time pressure, is to work out a diagnosis and treatment plan and decide whether to admit or not. In general practice a more incremental style is needed. This entails participating in a continuum involving a number of visits that may be required to diagnose and develop a management plan.

Preoperative iron management has improved on the North Coast in the last 18 months. However there is still room for further improvement, particularly in major bowel surgery. The local co-ordinator of the project, Beverley Hiles, reports on progress to date. 

The Australian Commission on Safety and Quality in Health Care has been conducting the National Patient Blood Management Collaborative (NPBMC) since July 2015. Lismore Base Hospital and Lismore St Vincent’s Private Hospital along with the North Coast Primary Health Network have been a part of this national collaborative.

The aim of the collaborative is to identify and manage preoperative anaemia and/or iron deficiency in patients scheduled for elective surgery where significant blood loss could occur, namely in gynaecological, gastrointestinal and orthopaedic surgical streams. It is a key patient blood management strategy for optimising red blood cell mass before surgery while aiming to reduce blood transfusion which may be an independent risk factor for increased morbidity and hospital length of stay.

First Fleet in Botany Bay, 21 Jan 1788
General practitioners are small business owners working independently and unfamiliar with the process of tendering. The awarding of contracts is a discipline that has matured over the last 230 years. History has much to teach us. 
The loss of the American colonies in 1783 marked the end of transportation of British convicts to the New World. It is estimated that over 50,000 made the trans Atlantic journey in the century prior. The industrial revolution was changing British society and increasing numbers of workers were replaced by machines. The unemployed flocked to work in the cities but industrial growth was not strong enough to accommodate their number. Idle hands are the devil's workshop.