Comparison of two GP service provider models in older adults: a register-based follow-up study

Background: In Finland, there have been various strategies attempting to provide access to GPs. The 'restricted-List General Practitioner model' (rLGP) was launched in primary health care (PHC) in the city of Vantaa after the 'named General Practitioner model' (nGP) failed to provide sufficient access to GPs. This was done to improve access to GP appointments for those most needing care. Aim: To evaluate the impact of the transition from nGP to rLGP on access to non-urgent scheduled appointments among patients aged ≥75 years. Design & setting: A register-based follow-up study in public PHC in Vantaa, Finland. Method: The study focused on patients aged ≥75 years who used PHC from 2004–2008. It looked at the number of non-urgent and urgent scheduled appointments, patient contacts, home visits, PHC emergency department appointments, and cancelled appointments, which were recorded 7 years before and after the transition from nGP to rLGP in 2011 and adjusted to patient-years. Non-urgent appointments were booked to the patient’s own nGP or rLGP in public PHC, whereas urgent appointments could be to any GP. Results: The number of non-urgent scheduled appointments to GPs was halved during the time of nGP, before launching the rLGP. Simultaneously, the number of urgent scheduled appointments more than tripled. The number of both started to plateau a year before the rLGP was launched. The number of both non-urgent and urgent scheduled appointments remained mainly at that level after rLGP was implemented. Conclusion: The rLGP model was unsuccessful in improving access to non-urgent scheduled appointments to GPs.