Intended for healthcare professionals

News Roundup [abridged Versions Appear In The Paper Journal]

Dutch GPs in protest at modernisation plans

BMJ 2005; 330 doi: (Published 10 February 2005) Cite this as: BMJ 2005;330:326
  1. Tony Sheldon
  1. Utrecht

Dutch GPs have clashed with their government over pressures to modernise general practice without further investment, before the introduction of market forces.

GPs fear for the quality of their care as demands for larger multidisciplinary practices grow, with the introduction of a new market driven health insurance system on 1 January 2006.

Angered that they are not “being taken seriously” they have begun referring patients to hospitals and physiotherapists “sooner than they normally would.” Typically GPs are referring one or two patients a day earlier than before.

What began as a small regional action has now spread to cover most of Holland's 8000 GPs, resulting in an estimated 40 000 extra referrals a week. In effect they are loosening their long standing and highly efficient gatekeeper function, which has resulted in GPs handling 96% of patients' complaints on just 3% of the health budget.

The health insurers' umbrella body and the patients' and consumers' federation are “furious,” calling the action “premature and unnecessary.” The GPs say that the referrals remain in line with medical protocols.

And their strength of feeling was clear at a recent national rally attended by more than 3000 GPs under the slogan “A GP for every Dutch person, in the neighbourhood, with time for you.”

The dispute originates in last year's decision by MPs to exclude general practice from the new “no-claim bonus” scheme for public health insurance. (BMJ 2004;329:939). The scheme requires people to initially pay higher annual health insurance premiums with money later refunded to those who make little use of health services. Many GPs had lobbied parliament arguing that general practice should be excluded from the scheme.

But scrapping the €5 (£3.43; $6.47) charge proposed for each visit to a GP under the no claim scheme has left a gap in the primary care budget, claimed the government. A €50m fund for modernising GP practice was consequently frozen. Health insurers then proposed freeing up funds for modernisation by increasing average practice list sizes from 2300 to 3000. Practices would then receive more money through reimbursement, which could be spent on support staff.

GPs saw this as “the straw that broke the camel's back,” and while the plans were withdrawn the regional actions have gained momentum.

Demands from the national GP's association include funding for larger group practices, extra expertise, and offering supplementary treatments; an extra €68m for support staff, such as practice nurses; and funding to retain older GPs, as one fifth of the profession are set to retire within seven years.

The association spokesman, Fulco Seegers, said that GPs fear that their profession is in jeopardy: “The minister is saying you must modernise, but there is no money. Modernisation needs money, we are merely asking for adequate reimbursement of practice costs.” Minister Hans Hoogervorst argues that GP care has already been explicitly protected from an overall 0.8% saving in health spending. He believes that Dutch GPs' salaries and work pressure compare favourably with other European countries.

Talks have begun with the ministry of health, but the national GPs' association is set to meet next week to consider stepping up the action.

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