the columnist

Published: 20/11/2003, Volume II3, No. 5882 Page 17

Tom Coffey is a south London GP and professional executive committee chair, Wandsworth PCT

The Department of Health, the King's Fund and even health secretary John Reid recognise that US healthcare providers have much to teach the NHS.

A report by the DoH on California-based Kaiser Permanente shows a significant reduction in length of stay compared to the UK and an admission rate which is a third of the UK's.However, we seem to know very little about healthcare providers in Europe and the rest of the world.When I asked at a recent healthcare conference if anybody knew how France managed its diabetes sufferers, I got a lot of blank looks.

But my patients demonstrate the potential learning from continental Europe and further afield.

Mrs B was was found to have an ovarian cyst. I referred her to St George's Hospital in nearby Tooting and explained that she would be seen within 21 weeks and operated on within six months. She returned to see me four weeks later. This often occurs because a patient has yet to receive the outpatient date and I was ready to hassle the hospital.However, what she requested was for me to remove the stitches on her abdominal wound. She had rung her old GP in the Netherlands who had arranged for her to see a gynaecologist the following week. She had her operation 10 days later. I was flabbergasted that a country 50 miles from our shores can produce such an excellent response for my patient, free at the point of delivery. The Netherlands has a comprehensive healthcare system, funded by social insurance. It offers greater patient choice than the UK without any apparent loss in equity.

Ms D is French and had a prolapsed disc.

She was in constant pain and had numbness in her leg. She was no longer able to work even though she was in her mid-30s.We followed the usual course of painkillers and physiotherapy and she was now waiting for a discetomy. She, too, disappeared off to her homeland, sick of waiting, and had her operation. Of greater concern was her follow-up. In France, she had to go through 'Yellow Pages' to find a district nurse to come and remove her stitches. She had to do the same for her post-operative physiotherapy rehabilitation.However, her family GP was more than happy to see her and popped in quite a few times while she was recuperating. France has many more doctors than the UK, but interestingly their wages are 50 per cent less.

I spent three months working in accident and emergency in Queensland, Australia, in the 1990s. The consultant in charge told me very clearly that if someone went to a sweet shop asking for a gallon of petrol, they would be told to go to a garage. Equally, in Australia if a patient attends A&E with a primary care problem they are turned away to one of the nearby 24-hour primary care centres. The devolution of out-of-hours care to PCTs in 2004 may offer an opportunity to develop a similar model, otherwise the inexorable rise in A&E attendees will continue, and waiting times will again lengthen.

I am not denigrating the learning from the US health system, but ask that we also look elsewhere. Europe and Australia may provide the answers to some of the present NHS stumbling blocks and also allow us to predict where the patient choice and funding flows initiatives will take the NHS.