Some of the readers of this report will possibly be unfamiliar with the origins and purpose of the GPAH (General Practitioners as Advisors in Hospitals - in Danish "Praksiskonsulenter") and of the functions and results obtained by and expected from this organisation.

To evaluate the results obtained to date by the GPAH system, the past and planned future development hereof are described in the following.

The GPAH idea started with a wish to face the fact that problems were being experienced in the interaction between hospital doctors and general practioners in the treatment of the patients on their way through the health care system.

Subsequently this was expanded to include a wish to suggest improvements, which resulted in the foundation of the GPAH on the island of Fyn in 1991 with a description that today reads:-

"The organisation called "General Practitioners as Advisors in Hospitals" is a network of general practitioners who seek to safeguard and strengthen the co-operation between the hospital, the general practitioner and the public home care authority, thus benefiting the patient by ensuring continuity and quality of treatment in both the primary and secondary sectors".

The GPAH system has now been introduced in all the counties of Denmark.

In most of these, the development of the system is proceeding well in a joint effort between the hospitals, the National Health Service, the County Authority and the Board of Local General Practitioners.

To date only a few counties have employed a GPAH with a Local Authority.

Terms of employment and salary levels vary from county to county, as do the terms of reference for the GPAH, which are adapted to local conditions.

In an attempt to enlarge and unify the GPAH system, all the GPAH and co-ordinators were sent a questionnaire in March 2000, and the returns have inter alia provided the background for this book.

It is quite clear from the answers received that the GPAH are thoroughly committed to and anxious to tackle the work.

As a beginning, the communication between the hospital and the GP was given priority since it was recognized that a closer understanding of each other's daily functions is a prerequisite for the development of closer co-operation.

Meetings were held at the hospital and in the GP's office, where arrangements were made with regard to mutual availability, and telephone numbers, telefax numbers and e-mail addresses were exchanged.

The work of improving the communication between the parties and including the use of electronic communications has led to improvements in the referrals and discharge letters that are the means by which the patient's condition are communicated between the GP and the hospital and visa versa.

Training programmes on both sides have been conducted in many places, where the involvement of the GPAH in the relationship between the GP and the hospital doctor has led to changes in practice both at the hospital and with the GP. In such cases it has been essential to include the Local Board of General Practitioners to ensure the acceptance of the changes that can affect the GP's methods and time.

At a later stage new clinical guide-lines have been introduced in various forms, such as regular news letters sent either direct to the GP or published in local medical journals or as major clinical guidelines in respect of specific illnesses for use on a county-wide basis as well as a few nation-wide clinical guidelines compiled jointly with the Danish College of General Practitioners.

In connection with the preparation of such guide-lines The Association of General Practitioners has been closely involved and will continue to be involved as the negotiator with the National Health Service in respect of the consequent revision of charges.

Expressions and thoughts with regard to patient progress and shared care are beginning to come into daily use.

It is also apparent from a number of places that the next step after clinical guidelines will be quality control programmes fostered by local quality development committees possibly in co-operation with research units and institutes of general medicine.

It is inspiring to read the chapters written by colleagues and partners who take part in discussions of the GPAH system. Ideas for future developments have come from consultants, from hospital management, from the County Authorities, from politicians, from the Minister of Health, from the Danish College of General Practitioners and from the Association of General Practitioners.

The contributions to this interim report point the way to the functions, demands and expectations that will ensure the continued viability of the GPAH system.

Finally it is stressed that the essence of the GPAH system is to break down the barriers between the hospital and the GP so that the' patient feels a sense of continuity in diagnosis, treatment, information and follow-up in the health care system.

Incidentally this will also often lead to a more efficient use of financial resources to the advantage of the health care system as a whole.