191 General discussion include a discussion on the specific health tasks and roles GPs and GP-practices should have. Thereby it should be discussed what kind of role we see for GPs with respect to prevention programmes, such as the CSPs. As this thesis shows, GPs are in the position as well as both capable and willing to play a substantial part in the CSPs, and it appears that some patients, or at least a certain group of patients, also prefer greater involvement of GPs. In previous literature it was described that screening-eligible people appreciate contact with their GP when it comes to participating in cancer screening.56 If ‘we’ consider cancer screening participation to be of significant importance, then ‘we’ should ensure that GPs and GP-practices are able to empower the CSPs. Recent studies stated that GPs are interested in taking a more active role in preventative healthcare, yet the broader appeal for greater emphasis on prevention is not being adequately addressed.57, 58 What might help is that GPs themselves speak up and declare even more prominently what they are able and willing to do, and what not.59 Given our studies, our understanding from daily practice and international literature, we strongly believe that primary healthcare providers can play a key role in the optimalisation of the current CSPs. Thereby I hope that the concept of ‘trust’ in the healthcare system and healthcare professionals returns, which might also contributes to a reduction and emphasis on filling out all paperwork, the so called famous ‘Paarse Krokodil’ (Purple Crocodile).60 What do general practitioners want? Over the past few years we have spoken to many GPs and asked GPs them what they need in order to empower the CSPs in the future, they roughly responded with three answers: I) more GPs are needed, II) GP-practices should become smaller, i.e. fewer patients per GP, and III) better/more funding is needed for the entire (primary care) healthcare system. It can be said that the government has been working on increasing the number of GPs for years. Nevertheless, it still does not seem easy to educate more GPs, especially in the more peripheral areas of the Netherlands. The workload remains high, and additionally there is an issue of a significant shortage of support staff for GPs continues to persist.61, 62 Therefore, a significant challenge emerges for various stakeholders in primary care, as well as for society at large. The National General Practitioners Association (LHV; Landelijke Huisartsen Vereniging) has been arguing for a long time for smaller number of registered patients per GP-practice and stated that a norm practice should consist of about 1800 patients.63 Although the practice size per GP has indeed decreased in recent years – from 2350 patients in 2006, to 7
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