Introduction of the patient-list system in general practice Changes in Norwegian physicians’ perception of their gatekeeper role

OBJECTIVE: To explore whether the patient-list system, recently introduced in general practice, has influenced general practitioners' (GPs') self-perception as gatekeepers. DESIGN: Structured focus group interviews with GPs and a short self-administered questionnaire. SETTING: Primary care within the public health care system in Norway. Group interviews were conducted 6 months to 1 year after the patient-list system was introduced in June, 2001. SUBJECTS: 81 GPs attending tutorial groups or specialists' continuous education groups. OUTCOME MEASURES: GPs' experience with the reform as stated in 11 group discussions, recorded, transcribed and systematically analysed through coding and extracting of the informants' statements. The questionnaire provided background information about each participant. RESULTS: The doctors generally perceived themselves as less concerned with the gatekeeper role under the new system. They felt it more important to provide better services and keep patients satisfied. The practitioners explained this shift using three contextual factors: increased and more visible competition, higher expectations from the patients and more responsibility assigned to the GP. CONCLUSION: GPs in Norway have experienced a shift in power in the physician-patient relationship favouring the patient. The GP's consciousness of the gatekeeper role has diminished. We question whether the new system lessens the incentive to consider resource use in decision-making.