Hausärztlich arbeiten in Deutschland und anderswo – Erfahrungsberichte

Background: The framework conditions of primary care differ between individual European countries. We aimed to investigate how system differences (predetermined factors over which individual general practitioners have no influence) between countries influence practice. Methods: Within the framework of a qualitative interview study, 12 general practitioners (GPs) who had worked both in Germany and in another country (Great Britain, Italy, the Netherlands or Norway) were asked which major differences between Germany and the comparison country they perceived in their work. The interviews were analysed using thematic analysis according to Braun and Clarke. Results: Three themes were discussed by the participants. (1) The strong gatekeeping function of GPs in Great Britain, the Netherlands and Norway leads to a wider medical spectrum. In Italy, the gatekeeping function is weakened by various factors. (2) Strong differences in remuneration and billing mechanisms set complex incentives that affect GP care in a variety of ways—some of which are negative. This was the most discussed topic. (3) If, as in the Netherlands and Norway, the issuing of incapacity certificates is not a GP task, this leads to fewer visits to the doctor that are perceived as unnecessary. Conclusion: From the participants’ point of view, the system differences between the countries studied are large and even minor regulatory details can have a significant impact on GP work.