Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

108 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90
6.6.4 Summary: new policies according to the stakeholders
Some major themes emerged in the new policies mentioned by the stakeholders:
1. The society is changing. The patient should be educated to use properly
the health care system. The young GPs privilege their private life to a
career and are not ready to accept any patient’s will. The current
tendency to work in group practices seems a solution for most problems
including duty, continuity and training.
2. Medicine is changing with a growing bulk of information. This implies a
modification of the lectures, of the continuous medical education and of
the selection of the information by the GP to decrease the workload. The
organization of the profession should be under the responsibility of the
GPs themselves: the promotion of some spots to install a practice, the
follow-up of the duty service, the links with hospitals, specialists and other
health care professionals from the first line.
3. The GP’s role in the health care system is crucial: he knows best the
patient. However, the increasing need for scientific knowledge urges for a
multidisciplinary approach (during training, during practice and in all
aspects of collaboration).
4. Money is not essential although it is necessary and it will help to
overcome some great difficulties (duty, computing). Other incentives are
more important e.g., social status, maternity leaves, help in socially
deprived zones.
6.7 WHY DO THE STAKEHOLDERS PREFER SOME POLICIES?
6.7.1 Introduction
In the previous part, policies were prioritized according to their scores or ranks.
However, this does not explain why some policies are preferred or discarded. Even if
some policies got a decent score, none reached a majority as the first-preferred policy:
the highest mean rank was 1.81 for the integration of a GPs’ perspective into the master
courses (teaching topic) and 1. 91 for the support of an evolving career (work-life
topic). Conversely, very popular policies being today considered or having been recently
implemented (such as the increase of the consultation fees) received a low support
(mean rank of 2.69).
If one wishes to implement a policy, it is important to anticipate why some policies are
either preferred or rejected. Understanding the hurdles to be faced is a first step into
figuring out how to take them seriously into account or to bypass them. There are two
ways of doing that: considering policy criteria and stakeholders characteristics.
First, health policy decision making depends on how well these policies meet different
values, that we called “the criteria”. According to previous researches on health care 198
, 204 , 207
, the choice of a particular policy depends on how well it fulfils the values that a
stakeholder has in mind. In this research the policies to improve GP’s attraction,
recruitment and retention were assessed on 4 criteria (see method). The first question
to ask is therefore “What is the contribution of these criteria to the stakeholder’s
choice?”
Second, another tenet of this research is that different policies can command varying
support from different groups, because groups do not have the same objectives, do not
face the same accountability rules and, finally, do not share the same socialization and
decision-making opportunities. For example, GPs may feel much more responsible for
their patient while policy-makers may feel much more liable for the society perspective.
But there are many characteristics that matter. Indeed, a stakeholder belongs to
different interest groups, to different language communities, he may have been trained
as a physician or not, he may work for an organisation having high or low power on the
issue. Stakeholders may have different understanding of the issues and may have, as an