A Tale of Two Systems: Reflections from a GP Observership

Abstract

Stepping into an Atención Primaria de Salud (primary care centre) in North Madrid felt at once familiar and foreign. The waiting room buzzed like any busy NHS GP practice, yet the rhythm inside the consultation rooms told a different story — brisk six-minute appointments, on-site ultrasound rooms, and paediatricians just across the corridor.

Over two weeks, I shadowed GPs, paediatricians, nurse practitioners, and phlebotomists; observed ultrasound sessions; visited the local university hospital and pharmacies; attended regional primary–secondary care meetings; and joined a GP training session. What began as an observership soon became a fascinating comparative study of two healthcare systems built on similar ideals but shaped by very different contexts.

Introduction

The Spanish National Health System

Spain has a high-quality healthcare system that guarantees almost universal coverage for all residents. Just over 99% of the population receives public healthcare (asistencia sanitaria pública) through the National Health System (Sistema Nacional de Salud – SNS). Many residents also hold private insurance to supplement public coverage, shortening waiting times or adding benefits.

This hybrid model offers broad accessibility while maintaining an element of choice and flexibility — an interesting contrast to the NHS's single-payer design.

Inside Spanish Primary Care

Primary healthcare in Spain is delivered through local health centres staffed by multidisciplinary teams — typically family doctors, paediatricians, nurses, and physiotherapists. While some centres allow patients to book with a specific doctor, most operate a pooled system, ensuring rapid access though sometimes at the expense of continuity.

Spain also runs a co-payment system for prescription medicines, meaning residents contribute a fixed percentage of costs. Working-age adults pay up to 60% depending on income, while pensioners contribute around 10%. This subtle but significant difference from the NHS — where there is a fixed charge per prescription — influences attitudes toward medication, especially for chronic conditions.

Analysis

Pediatrics in Primary Care — A Model Worth Noticing

One of the most distinctive features of Spanish primary care is the integration of community pediatricians within GP surgeries. In Madrid, all children up to 14 years are routinely seen by pediatricians who work alongside family doctors in the same health centre. This co-location enables immediate specialist input, fosters collaboration, and offers parents greater reassurance.

The result is an elegant redistribution of workload — blending accessibility with expertise, streamlining patient journeys, and reducing unnecessary hospital referrals.

For a UK-trained GP, where the generalist model dominates and pediatric input is largely hospital-based, this approach offered a compelling contrast. It showed how aligning specialist and primary care within one setting can improve efficiency, learning, and patient satisfaction.

A&E Without Medicines — and What It Reveals

At a regional meeting between hospital and primary care clinicians, one debate dominated: whether emergency departments should dispense medication. In Spain, A&Es do not supply medicines directly. Instead, patients are discharged with a prescription for their GP or local pharmacy — even on weekends or public holidays.

While this clearly delineates responsibilities, it can delay treatment. Primary care representatives argued that it disadvantages vulnerable patients, whereas emergency physicians feared that changing policy would increase workload and crowding.

The discussion underscored how a small operational difference — in this case, medication dispensing — can profoundly shape patient experience. It also highlighted the relative privilege of the NHS model, where providing medicines directly from A&E is routine and often taken for granted.

Shared Problems, Different Languages

Despite structural contrasts, many of the meeting's themes felt strikingly familiar: the overuse of PPIs, the rising cost of specialist-initiated drugs, and the perennial tension between primary and secondary care.

These conversations reminded me that the challenges of modern healthcare transcend geography. Whether in Madrid or Manchester, clinicians face the same pressures of resource allocation, prescribing practice, and coordination. The problems are shared — only the language differs.

Perhaps the solutions should be shared too. Stronger international collaboration could accelerate learning and help refine systems not in isolation but through collective experience.

Consultations, Culture, and Communication

Spanish consultations are short, directive, and doctor-led — a sharp contrast to the shared decision-making ethos of UK general practice. Yet within that paternalistic style, there was evident trust and satisfaction. Patients expected decisiveness, not deliberation.

What surprised me most were the "thank-you appointments": brief visits where patients returned simply to report that they were now well or that previous treatment had worked. In the UK, we rarely see our successes — only the complications. The Spanish approach was a refreshing reminder that positive feedback can be as restorative for clinicians as it is for patients.

Mutual Exchange and the Human Side of Healthcare

I also delivered a presentation to my hosts on London, UK medical training, and the NHS structure. The discussion that followed was lively and insightful, exploring how both systems train and support doctors.

Beyond the professional learning, I was struck by my hosts' warmth and generosity. They were eager to explain local practice and make my visit culturally enriching. The sense of collegiality transcended language barriers, and our conversations often wandered from medicine to music, culture, and family life.

Implications

Reflections on Comparison and Collaboration

By the end of two weeks, I returned to the UK with more than notes — I came back with perspective. Some things Spain does better; others, the NHS. The Spanish model's integration of paediatrics and structured collaboration between hospitals and primary care felt progressive. Conversely, the NHS's emphasis on continuity, shared decision-making, and free access to medicines stood out as patient-centred strengths.

The differences are not deficiencies — they are opportunities for mutual learning. In an era of shared global challenges, from multimorbidity to workforce strain, experiences like these highlight how much we gain by looking beyond our own borders.

Conclusion

My time in Madrid was brief but deeply instructive. It rekindled curiosity, empathy, and perspective — qualities that can fade amid the routines of daily practice. I left inspired by the professionalism of my Spanish colleagues and newly appreciative of the diversity of ways in which primary care can thrive.

International observer ships expand clinical horizons and renew the essence of why we practice medicine — something every doctor should experience at least once.