Training and scope of practice of GPs in Europe- A qualitative study in three European countries

Background: The current EU Directive 2005/36/EC has established a minimum training duration for post-graduate qualifications, leaving definitions of skills required and scope of practice to national authorities. Increased mobility of health professionals and lack of standardization is leading to increasing concerns regarding fitness to practise safely in another European country and quality of care. However there is little comparative research on GPs’ across Europe. This paper seeks to address this gap by examining the commonalities and differences in training, continuing medical education, scope of practice, ethical issues and things that need improvement in England, Germany, and Spain.

Method: Qualitative study with 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.

Results: Entrance to and length of GP training differ between the three countries, with continuing medical education being present in all three. 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. GPs in these countries face 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.

Conclusion: Primary 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 information source for GPs moving to another country.