The organisational structure of a GP practice in New Zealand and in Germany: A basic difference.

Now working in the third practice in New Zealand, I dare to make some generalisations:

A fundamental difference between a GP practice in Germany and one in New Zealand is the degree of applied hierarchy. This has cost me quite some effort to accept it and adapt. I am quite convinced that, in principle, this difference applies as well to other organisations and companies.

Now, my practice in Germany had a kind of pyramidal hierarchical and organisational structure. And I think this was quite typical. As the employer, I was the head, first alone, then with my colleages of the joint practice. Everyone else relied on me – or us - and trusted me/us. As the most experienced and long-standing owner my structure sort of coined the whole thing. On a second level, I had my „Ersthelferin“, the main „doctors helper“ (which is a literal translation from this professional term), who took my ideas and – importantly – checked them for practicability. Also, she added her own ideas. Only with her I was able to act as an organisational pillar. Another function of her was to act as a mediator between me and the other Arzthelferinnen, doctor's helper, and accommodate them. Apart from that, we held regular team sessions and on demand I discussed personal difficulties with staff especially if this was necessary. In Germany the GP is held responsible for everything his helpers do. Their, task, in turn, is to help the GP to work with more efficiency, but what they do are all his original tasks – like venosection, basic diagnostic measures like height, weight and BP, allergy tests, ECG, Doppler etc. They also do therapeutic measures (e.g. dressings, electrotherapy) and prevention, but everything it is in order to help the GP. Of course there is a range of non-delegable tasks like the most of the physical examination itself, ultrasound and others.

There is no such distinction between receptionist and nurse.

Now, in New Zealand the practice rests on three pillars. The profession „Arzthelferin“, doctor's helper, doesn't exist as such. On the first sight, her tasks seem to be done by the receptionists and the admin staff on the one hand and the nurses on the other. The GP is the third pillar. Everyone has his own tasks and day structure and is held responsible for this (as far as I understand until now). The GP is, in most or al least many cases, still owner of the practice. However, the NZ nurse has a different understanding of her role. She is not primarily there to help the doctor but has her own schedule, or template. The concept is that all constituents of an NZ GP practice are expected to „be happy to help“ each other but there is also the expectation that the „consumer“ or addressee of the helping hand is aware of that this is a friendly help and not the original task of the helping person. You can say that an invisible and unofficial „account“ exists that should, at least in the long run, be held in balance, and that the „withdrawals“ are done by either side. This, if it works well, is then called „team spirit“. This system can be visualised as a structure like one of these classicistic gates, where a roof, the team spirit, rests on three pillars. A New Zealand health professional might have difficulties believing that a team spirit can equally be percieved in the German model of a GP practice, which I would compare to a pyramid with the GP(s) at the top, then the main Arzthelferin (who often acts as the practice manager, a task done by admin staff in NZ), and „below“ the rest of the Arzthelferinnen. They might see their role as equally fulfilling. As an analogy someone might use the traditional, almost overcome European role model of a husband and his wife. Surprisingly, the cleaner seems not to be seen as a part of the team in NZ; this will also vary in Germany.

The task of the GP in Germany is now to create an atmosphere of generosity and courtesy that makes the employees feel appreciated. A further incentive for the Arzthelferin to feel comfortable in her role is that virtually all responsibility lies with the GP.

The basic difference of the structures is mirrored by the fact that the health centre in Germany traditionally carries the name of the GP, whereas in NZ it is often the name of the town.

This in turn lines up with my basic perception that simple institutional hierarchies are taken with much caution in New Zealand, but still based on a strong tradition in Germany.