Martin Lawrence Scholarship recipient Antonia-Olivia (Annie) Roberts' reflections on primary care in Malmö

This year I was lucky enough to receive the Martin Lawrence Scholarship to study primary care in a Nordic country, which took me to the surprisingly sunny shores of Malmö, Sweden’s third largest city. Malmö is known as the ‘city of parks’ and is very international, being the closest point in Sweden to mainland Europe. Fans of Nordic Noir may also recognise Malmö from the TV show The Bridge, as it’s linked to Copenhagen by the Öresund Bridge.

I undertook a one-week placement at Vårdcentralen Granen (The Fir Tree Health Centre) – the largest health centre in Malmö. Healthcare in Sweden is not nationalised but is instead organised by region – so my practice in Malmö was regulated and funded by Region Skåne. Swedish healthcare is not free, but operates under a copayment system. A GP appointment costs 200 SEK (£15.50) and a trip to A&E costs 400 SEK (£31) in Skåne. Some medications are partially paid for by the state, but the cost of many medications is higher than the UK and there is a higher maximum annual prescription fee (UK £114.50, Sweden £295).

my placement at Vårdcentralen Granen

The vårdcentral seemed like a lovely place to work featuring, as one might expect, minimalist Scandinavian interiors, large break rooms and beautiful gardens. I was pleased to see all staff were as keen on ‘fika’, or coffee breaks, as I am. The atmosphere was less rushed than GP practices I have had placements at in the UK, with doctors seeing around 6-7 patients per session and nurses 4-5 patients per session.

One notable difference from GP practices in the UK was the size of the health centre. In addition to GPs and nurses, the centre also employs dieticians, a psychologist, a physiotherapy wing, and includes a floor dedicated to child health with a drop-in kindergarten, which means the vårdcentral can act as a ‘one-stop shop’ for many kinds of healthcare. They also employ a ‘kurator’: a cross between a social worker and a counsellor who helps people with moderate mental health problems to navigate the social welfare system and return to work, hence reducing the number of people on long term sick leave.

The vårdcentral was also able to carry out procedures which would be done in secondary care in the UK, such as proctoscopy and intravenous infusions. This helps to limit the number of patients needing to be referred to hospital for further investigations and procedures. My time at Vårdcentralen Granen was an overwhelmingly positive one where I took away many insights into practices that the NHS would do well to consider. However, I also observed several systemic factors that could affect the success of this primary care model – for example whether the vårdcentral in general are adequately set up to deal with adverse events. Whilst I was there, one patient had an allergic reaction to an iron infusion and had to be taken to hospital by ambulance. Although she recovered, the clinics would not be able to offer supportive care for patients with refractory anaphylaxis.

A new development that threatens public healthcare in the region is that private health clinics are becoming increasingly popular in Malmö, as they offer shorter waiting times and more continuity of care. This threatens the financial security of the vårdcentral, as, when patients move away, so does their funding from the state. Unfortunately, this means they have had to lay off some staff and as a result, the practice manager as well as many members of staff seemed very keen to offer a positive patient experience to retain the patients they have.

visiting Läkare i Världen (Doctors of the World)

Sweden has a reputation for being welcoming to refugees, so whilst in Malmö I visited a refugee health clinic run by Läkare i Världen (Doctors of the World). I shadowed the doctor and nurse who volunteer to run a drop-in medical clinic. The main function of the clinic was to signpost patients to correct part of the healthcare system and to advocate for their needs. The rules regarding healthcare for asylum seekers in Sweden are very ambiguous. Asylum seekers are entitled to emergency care and other ‘care that cannot wait’. Unfortunately, mental health and substance misuse are often regarded as not falling under this definition, which is where the role of Läkare i Världen comes in, as they can write letters advocating for their patients’ right to be seen and their right to discounted healthcare. The other key role the clinic plays is in offering psychosocial support, with their psychologists offering a space to listen and provide emotional support. This is a vital service for people who may be a long way from their support networks at home.

Whilst we may think this charity is clearly acting for the public good, other institutions may not see things the same way. According to the volunteers I spoke to, the centre, which is shared with other support groups for migrants and refugees, has already been visited by the police five times in 2025 alone. They have a protocol to deal with these intrusions, but it is sad that police encroachment into spaces of healthcare is now seen as routine.

experiencing the Medicinsk Museion in Copenhagen

During my trip I also visited the Medicinsk Museion in Copenhagen, situated in the old Academy of Surgeons, where dissections were carried out. One of the most striking features was the collection of historical pathological specimens, including conjoined twins, deformed foetuses and a full-term foetus inside her mother’s uterus. My instinctive reaction was of horror and revulsion, but I think this ascribes a negative morality to these foetuses which are entirely blameless. Indeed, my reaction of disgust regarding the physical form overlooked a much more important aspect to the tragedy – that of a family losing a future child, and the consequent grief and bereavement.

This collection also raised the issue of whether such specimens should be displayed to the public because their parents had not consented to this. Creating and displaying new specimens without consent would clearly be unacceptable now, but is it right to apply our current moral values to the past? At the time, preserved specimens would have been an invaluable resource to trainee doctors and the concept of informed consent was undeveloped. On the other hand, we may consider there to be some actions that are so clearly wrong that we can apply modern values. The museum had an ethics room with voting stations, suggesting that there is no clear answer to these questions and indeed, the visitors responses varied considerably.

During my time in Sweden, I also had the opportunity to visit Stockholm and its surrounding archipelago – the largest archipelago in the world with over 30,000 islands. These were full of picturesque wooden houses and beautiful nature reserves, highlighting the importance of the outdoors in daily life. The entire experience was amazing and gave me such an insight into many facets of Swedish and Danish life. I certainly learnt much more about Sweden and Denmark by undertaking my placements than I would from a simple tourist visit.

I would like to thank Annette Lawrence and the Lawrence family for giving me the opportunity to experience healthcare in a Nordic setting and for their mentorship of students with an interest in primary care.