status quo of quo vadis? - KCE

30 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76
2.4.3.4 Future developments
The Dutch College of GPs give an orientation for the future directions of general
practice.
The set of clinical indicators will cover other topics as for instance depression and low
back pain. Currently GPs may earn more if they declare to work according to some
guidelines or use the quality box but in the future, accreditation might be used to select
practices and fine tune payments. Practices that do not undergo the accreditation may
in the future be liable to other quality control by Health Authorities. However, a special
attention is needed for the data extraction from the medical records: this seems
currently to be a major burden for the GPs.
2.4.3.5 Learning points and suggestions for Belgium
The College plays a major role in the field of general practice, although the changes in
the design of the health care system may weaken its position.
The accreditation system is similar to the Australian one. The three-year process
encompasses multiple quality cycles. The hypothesis is that the repeated visits and the
support of the visitors who act as tutors may lead to quality improving effects.
The budget for the practice accreditation program is great. The organisation is well
outlined and may be performed by a non-doctor (i.e. practice assistant) who acts as a
quality manager. The independent visitors are not doctors but specifically trained. A
third party under the supervision of the college supports the GPs.
The number of clinical indicators is small but the items are well referenced (see
appendix 6). Until now, no firm data exist to show that the new accreditation is cost
effective.
2.4.4 United Kingdom
2.4.4.1 Organisation of the health care system, with focus on family medicine/general
practice
The current status of the health care context in the United Kingdom is heavily
influenced by political and historical developments. Large reforms were introduced with
changes of governments, especially from 1979 onwards. The National Health Service
(NHS) was introduced after the Second World War GPs have worked in private
practice since the start of the NHS (1948), although almost all their work was done
under contract with the NHS. Hospital doctors became salaried employees in 1948. 80
Today the NHS is organised in Strategic Health Authorities and Primary Care Trusts
but the health system often go through changes.
The government controls the budget of the NHS (tax-based). Out of pockets payments
exist mainly for specific services in hospital care and for pharmaceutical, dental and
optician services. Private insurance for these services has been increasing till 1990 and is
available for working people, often as part of a income package deal. 80
From 1990 onwards the District Health Authorities (DHA) were required to assess the
health care needs of their population and, from its weighted capitation based budget, to
commission a range of services from providers to meet these needs. Each DHA had a
department of public health responsible for carrying out the needs assessment. A
contract system was introduced to formalize the link between purchasers and
providers. 80
The health care system has a strong primary care focus. GPs perform 90 percent of the
total medical patient contacts. The average number of GPs per practice is about three:
their patient list counts approximately 1700 patients.
From 1991 to 1998, 294 GP fund holding schemes (GPFHs) were introduced. The
principle was that groups of practices had a budget to purchase potentially all the