Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias
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KCE Reports 90 Making G<strong>en</strong>eral Practice Attractive: Encouraging GP attraction and Ret<strong>en</strong>tion 125<br />
issue that needs to be addressed. In Europe, reforms of the primary care sector have<br />
followed one of the following models 226 :<br />
• Increase the power of primary care as purchaser or coordinator and<br />
gatekeeper;<br />
• Broad<strong>en</strong> the service portfolio of primary care;<br />
• Provide supportive conditions in order to promote a stronger role for<br />
primary care;<br />
The stakeholders’ analysis suggests that most GPs in Belgium would be ready for the<br />
least radical reform (the 3rd one) but the readiness for the second one is unclear. On<br />
the one hand the multidisciplinary team was considered as valuable, but on the other<br />
hand the delegation of clinical tasks and the nurse-assistant practitioner did not get high<br />
support. This ambiguity is not unique and parallels the difficulties the improved role of<br />
primary care as coordinator has faced in countries (like France and Germany) with<br />
health insurance scheme 226 . The main reason why pro-coordination policies have failed<br />
in the health insurance countries (like France and Belgium) is the weakness of the<br />
primary care professionals and the blocking of powerful professional associations 226 . As<br />
a result, pro-coordination policies have t<strong>en</strong>ded to emerge as hospital-c<strong>en</strong>tered (or<br />
sickness funds c<strong>en</strong>tered) instead of primary care-c<strong>en</strong>tered. Local GP groups such as the<br />
GP "kring<strong>en</strong>/cercles" could come out as significant long term partner to broad<strong>en</strong> and<br />
integrate the services primary care provide at the local level. The Interdisciplinary<br />
primary care organisation -SISD/SIT) is an opportunity for GPs to catch-up with this<br />
coordinator role, which was, in March 2008, considered as key health policy in the<br />
Belgian Governm<strong>en</strong>t declaration. As suggested elsewhere 226 , curr<strong>en</strong>t developm<strong>en</strong>ts in<br />
care coordination may risk op<strong>en</strong>ing an av<strong>en</strong>ue to coordination without the primary care<br />
in the driver’s seat. That would be reduced still further attraction, recruitm<strong>en</strong>t and<br />
ret<strong>en</strong>tion of g<strong>en</strong>eral practitioners into the profession.<br />
7.6.3 Getting the message through<br />
The GPs have many institutions and levers to make their case: academic c<strong>en</strong>ters of<br />
g<strong>en</strong>eral practice for teaching, GP professional associations (e.g. FAG, Domus Medica),<br />
Sci<strong>en</strong>tific GP societies (as the SSMG) and Unions. They also have local associations<br />
dealing mainly with on-call services; they sit along governm<strong>en</strong>tal bodies in the<br />
INAMI/RIZIV funding bodies (medicomut), through medical unions. The question is<br />
whether these bodies can unite to reach a coher<strong>en</strong>t and overall strategy. The<br />
Interuniversity ICHO in Flanders and Domus Medica are illustrations of attempts to<br />
group GP institutions in order to promote such coher<strong>en</strong>t strategy.<br />
This report brings to light that g<strong>en</strong>eral practice is in need of ambassadors and leaders to<br />
propose a radical, constructive ag<strong>en</strong>da and to negotiate the implem<strong>en</strong>tation of this<br />
reform with the public authorities.