Maria is one of the many elderlies who has lived her whole life in the rural commune P, situated in the mountainous area of Vrancea county. While P does not benefit from a general practitioner (GP), Maria has registered with one of the two GPs who take care of several localities in the area. Maria admits that the communication with her GP is very good, but she fears that the 2 days her GP is in present in the commune each week are not merely enough. A lot of people require medical attention in her locality, especially those like her with increased needs, given the age. There were times when Maria had to travel to another locality to see her GP. So, she is not so unhappy today.

Access to specialised medical care is even more difficult for Maria. To get to a specialised doctor, she has to ask family members or neighbours who have a car to drive her. If nobody is available, she takes a minibus at 7:30 in the morning, that only returns late in the afternoon, which is tiring for her.

Maria has diabetes and requires regular injectable treatment, but in the area, there is no medical facility where such routine procedures can be done. She found out that her neighbour, Ana, has performed such injectable treatment before for other neighbours and they did not had complications, so now she relies on Ana to do this procedure.

Given her medical condition, it is crucial for Maria to perform medical tests periodically. While a private mobile laboratory comes at the end of each month to run medical tests for the locals, it is difficult for her to set aside money to pay for them and so she cannot always afford them, putting her wellness at risk.

Maria feels very lucky to have a pharmacy in her commune, despite it being open only a few hours a day. She says that her friends in the nearby village are much worse off, as they do not even have access to a pharmacy, and their children who work in P leave with “bags of medicine” for them and other neighbours.

However, Maria feels she lacks dental services in the village, for which she has to travel to another commune to access. And even so, the dental office is very busy and waiting times for making an appointment could reach months, which is why she has neglected her dental care and now faces serious problems. She only hopes her grandson, who goes to school and already has problems with cavities, would be lucky enough to see a dentist more often, yet the chances are slim.

Maria realises that her access to medical services is limited, but she has adapted to the situation and has accepted the current state as it is. She is thankful for the little access that she enjoys and sympathizes with the ones that do not have these services.

Rose is a 29-year old young lady with a chronic condition, living in the northern part of North-Holland, The Netherlands. The area where she lives has been suffering from GP shortages for some time already, and some of the GP practices in the area are now being covered by a commercial GP service provider. Several such commercial operators are active in The Netherlands, with promises of a more business-like, efficient and effective service delivery. But these operators, too, have difficulty filling the duty rosters. In one instance, they had to resort to a substitute doctor who was only present two days a week.

Rose’s condition requires her to regularly update and renew her prescription medication; without it, she risks additional problems such as heart failure. Last autumn, she couldn’t get it. “The GP assistant simply told me that no GP was available to renew my prescription and that she didn’t know when one would be available again.”

She also needs to undergo regular monitoring and lab tests, which are normally performed by her GP as well, but could not be done now, either. She eventually managed to convince one of her other treating doctors to do those tests for her.

Rose: “I tried to switch doctors and register with one of the other general practices in this region. But none of them is taking new patients. When I only had medication left for one day, I pleaded with the assistant to renew the prescription for me, which she did. It’s actually not allowed, and I would hate to get her into trouble, but I was at my wit’s end. At least she helped me!”

In order to raise awareness, not only about her own plight, but about the GP situation in her area in general, Rose filed a complaint with the National Health Inspectorate, but received only a formal acknowledgment of receipt. She approached the regional health insurance company, spoke with the director of the commercial provider and discussed the situation with the local alderman – all to no avail. Everyone is aware of the problems, yet no one seems to be able to make solutions happen. They all point to each other for the ‘magic bullet’ intervention.

And Rose? “I have a new GP now, and feel lucky to have found one. But having a GP who is familiar with you and your condition should not depend on ‘luck’ in a rich country like The Netherlands. And I know there are many more people who still need to shop around to see a GP.”