Maivi Parv explained the shortage of family doctors, stating, "If we talk about how many family doctors we are missing, it's about 10 percent of those working with patient lists. That's more than 70 family doctors. Today, this gap is being filled through substitute doctors, but we still have several open positions, and we are actively looking for family doctors. Unfortunately, this problem has worsened over time, and we foresee it continuing to worsen," she expressed.

"Currently, 30 percent of family doctors working with patient lists are of retirement age. That's over 200 family doctors. This means they are entitled to take their well-earned retirement at any time, even tomorrow," Parv added.

Presenter Katrin Viirpalu asked whether, under the new system, people would now need to call a receptionist, disclose their health information and then wait to see if a family nurse calls them back and whether they would even be able to see a doctor. She also inquired about the solutions available to ensure people receive care if there are not enough family doctors.

Parv explained that the Health Insurance Fund has signed an agreement with a health agency that provides family doctor services.

"Regarding the health agency example, it's essentially additional support to reduce the workload of currently working family doctors. We have very competent family nurses who have taken on more responsibility. Family nurses handle minor health issues, extend prescriptions and are a significant help, allowing doctors to focus on more serious patients. On the other hand, family doctor teams now include clinical assistants, whose task is to manage non-medical issues, such as organizing patient appointments. They are fully integrated members of the family doctor's team, with clear duties and responsibilities, and they provide crucial assistance," Parv explained.

Speaking about remote consultations, Parv mentioned that it is another way to save both the workload and resources of service providers.

A single doctor to handle several patient lists

Parv explained the current challenges and future solutions, stating, "On the other hand, in terms of finding solutions, we currently have a system where family doctor services are based on patient lists – one list, one doctor. We see that we can't manage with this system. While it still works today, we need to enhance it with new organizational methods."

"We are exploring solutions where multiple patient lists can be handled by one family doctor or several general practitioners. These teams would include family nurses, home nurses, midwives and physiotherapists. We are currently running pilot projects in Tõrva and Rapla," Parv said.

"The family doctor works with an extended team, which allows us, for example, to serve three patient lists through one family doctor and their extended team," she added.

Parv acknowledged that this new way of working might cause confusion for patients. "We are looking for both the strengths and weaknesses of this system. We're asking for feedback from patients, teams and municipalities."

She also highlighted the importance of call centers in easing the workload of family doctors. "If a call cannot be answered immediately, the call center provides an option and the patient can receive a callback," Parv said.

Another solution she mentioned is digital service platforms. "This allows patients to submit their requests to the family doctor's team through a computer, at a time convenient for them – whether in the evening, on weekends or anytime. The family doctor will address it the next working morning. This digital platform has been tested by the Health Insurance Fund. We've tried it ourselves to ensure it has the necessary functionality and is secure. From the patient's perspective, it helps communicate the issue clearly. And on the doctor's end, the platform helps prioritize whether the issue requires urgent attention or can be handled later in the day or the next day," Parv explained.

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