1. Models of the out-of-hours care
- European experiences
Paul Giesen (Netherlands)
Morten Bondo Christensen (Denmark)
Janko Kersnik (Slovenia)

2. 1. Introduction, aims and program
aim:
Providing information on the different
organisation models of out-of-hours care in
some European countries.
Reflection on the benefits and the
disadvantages of the different models and the
position of de GP’s in future.
To chose the organisation model preferred.
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3. 2. Out-of-hours primary care
services throughout Europe
Paul Giesen
overview what are different organisation forms in
Europe
what are the general problems
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4. 3. Three different organisation
models of out of hours care
Danish solution by Morten Bondo Christensen
(Denmark)
Slovenian system by Janko Kersnik (Slovenia)
Dutch solution by Paul Giesen (The
Netherlands)
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5. Danish solution
Morten Bondo Christensen, Denmark

6. Slovenian system
Janko Kersnik, Slovenia

7. The ice berg of health care
HOSPITATLISED
SPECIALIST TREATMENT
PRIMARY CARE
SELF-TREATMENT
ILL
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8. The concept of FM/GP
First contact
…
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9. The practice of the first contact
Regular hours
– Emergency care
– Outside the GP/FP area
– Holidays
Out of hours
– Emergency care
– Usual primary care
– Outside the GP/FP area
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10. Principles
24-hours responsibility
catchment area (15 – 30.000 population)
network of appointed institutions (community
based)
rota system/deputising services (each doctor
with patients on the list has to paritcipate)
first contact (each patient needs a referral)
primary care emergency services doctors
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11. Strength
Primary care concept
in place
Better accessibility
Better availability
Personalised
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12. Weaknesses
Lack of human
resources
Cost effectiveness?
Involvement in
serious emergencies
Check point? (PHC,
hospital, patients’
homes…)
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13. Dutch solution
Paul Giesen, Netherlands

14. 4. Reflection to your own out-of- hours
care system: What is the strong and
weak side and what would be ideal?
Discuss with your neighbour {from other country, if
possible} (5 min) on the following questions:
structure of the organisation (scale, management),
distances to the doctor,
doctor: workload, satisfaction with work
personal and material support
who does the triage
position and cooperation in emergency care
(GP/hospital/ambulance)
benefits and disadvantages of the model
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15. Country experiences
Work in groups of 3 – 5.
Answer the questions regarding your country:
– How is out-of-hours care organised from the doctors
perspective.
– How is out-of-hours care organised from the patient
perspective.
– How is out-of-hours care organised from the health
policy/payers perspective.
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16. Lessons to learn
Reports from the groups:
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17. 4b. What would be ideal - with
reflection to your own system
1. organisation of out of hours care:
hospital/ambulance care, no duty for a GP
I am always on duty my own
small rota’s (groups <10 PG and <20.000
patients)
large scales co-operatives (groups > 50 GP
and > 100.000 patients
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18. 4b. What would be ideal - with
reflection to your own system
2. What kind of doctors 3. Triage
should do the out of myself
hours work? my wife/relatives
B. GP’s nurses/ call
C. specialised GPs centre
D. all doctors can do it
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19. 4b. What would be ideal - with
reflection to your own system
4. In case of 5. demands of patients
emergency
B. I am the first B. I accept all demands
responder C. I accept just urgent
C. Patient ring demands
ambulance or go to
hospital D. I accept all demands
D. I cooperate with but discourage non-
hospital/ambulance urgent demand
and divide tasks
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20. Conclusions
We poses the skills to deliver primary care in a
patient oriented way.
There should be systems in place to help reduce
the burden of workload.
There should be a sound division of work
between emergency care services and GP/FM
services in line with the needs of the
local/regional populations.
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21. Thank you for your attention!