status quo of quo vadis? - KCE

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38 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76 King and Wilson reviewed the process of development of quality care in Australia and possible actions to be undertaken. They report health care management issues like incentives to attract and retain rural GPs, blended payment systems and rewards for achieving targets (i.e. immunisation). King et al. explicitly list vocational training, development of standards for general practice, development of a general practice evaluation programme and the development of an independent accreditation system owned by the profession. 42 The future role for the Divisions of general practice is gaining importance because of increasing possibilities for central data collection. An example from the Adelaide Western General Practice Network is the Practice Atlas. Practice routine data processed at the level of the Network practices may use quality data as feedback or as business models and drive innovation in general practice in areas such as practice business systems, infrastructure/workforce development, and the effectiveness of health care delivered by health care providers / multidisciplinary teams. 135 2.4.5.5 Learning points and suggestions for Belgium The Australian accrediting bodies are independent. There are financial incentives of the government for the general practitioners and general practices. Independent accrediting bodies assure that data handling is anonymous and secure. Because about 40 percent of practices took the 3 year cycle, their accreditation system seems feasible. The costs per GP are moderate so not excluding small practices. The Royal College has a leadership in quality as it initiates and supports the quality initiatives. Unfortunately, there is no data on the effects of the system. General Practice in Australia is well supported by networks. These are the regional highly effective platforms. They support and interact with practices by providing data analyses, so that GPs can manage their practice professionally. In this respect the view as to see general practice as a business offers a way forward. The business aspect refers to the GPs who need up to date data on their professional behaviour, in order to answer rapidly to the demands of the public. Important enablers from the Australian example are: • A national certification of general practitioners and standards upon which the certification is based; • Standards at the practice level to ensure that there is a systematic approach to safety and quality development; • System supports, for example regional Divisions of General practice; • Profession leadership and active government partnerships; • The concept of seeing general practice as a business where GPs answer to demands of the public. The appendix 8 details the Australian indicators for accreditation. 2.5 SUMMARY AND CONCLUSIONS OF THE ANALYSIS OF FIVE COUNTRIES Table 4 gives an overview of the quality frameworks in the five countries and Belgium. GPs in Belgium still often work in single handed practice and have a small practice size. Apart from this, the working conditions are similar to those of the French GPs. This review shows that the countries focus on a more practice based approach: the UK, Australia, the Netherlands and Germany are some examples. Adequate legislation and funding, IT platforms, independent parties are important issues.
KCE Reports Quality development in general practice in Belgium: status quo or quo vadis ? 39 Table 4. Quality development initiatives in the selected countries UK AU NL G FR B GP practice size Single handed 1800 1100 2300 1000 1400 500, unreliable practices Minority Minority Majority Majority Majority Majority Gatekeeper Yes Yes Yes Colleges, Sometimes No No support by Government and Emerging: initiated Key players for Government and government support by by Government, Emerging: initiated by quality Government and strong support and insurance insurance but weak input of Government, weak development strong support college college companies Local in practice, database companies college input of college Very powerful, extending at Very powerful, national and national level, Powerful by National, slow IT platforms national, immediate regional, immediate practice based sickness funds Slow development development Formative, Formative, Summative or Summative and may be summative blocked Formative, summative formative Use of the quality Summative formative summative Formative by jurisprudence for outliers cycle No Yes Yes No No No National (practice National; accreditation) and independent regional, owned by but owned by Third parties Increase of income when National regional GPs college Commercial National National engaging in parts Small part of Small Increase of the quality income and for to cover Only for framework Large part of income accreditation expenses No accreditation Only for accreditation Emerging, very large Weak, test Evidence data sets Weak ordering No No No
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status quo of quo vadis? - KCE

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