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Table 2 Changes in the practice organisation and in the training of GPs

From: Patient experiences with family medicine: a longitudinal study after the Dutch health care reforms in 2006

- GPs started to be organized in large care groups contracting chronic care in disease management programs. From 2006 onwards the availability of a nurse practitioner for chronic disease management rose from a few percent to over 90 % (treating chronic diseases: Diabetes Mellitus, Chronic Obstructive Pulmonary Disease, Cardiovascular Disease, Mental Care), accounting for part of the rise in practice income. Between 2007 and 2012 practice nurses’ time rose from 5.5 to 11.0 h per 1000 patients per week.

- Broadening the diagnostic and therapeutic scope of the practice followed the selective incentives for extra services (± € 50 per service for minor surgery, spirometry, EKG, Cyriax injection, etc.).

- Primary care practices became larger with more GPs working in one center. The number of single handed practices dropped between 2006 and 2012 from 46 % to 39 %. The number of GPs rose slightly from 8612 in 2006 to 8879 in 2012 (3 %) and patients per fte GP decreased slightly. Self-reported GP-time rose from 21 to 28 h per 1000 patients per week.

- In 2008, the Dutch Association of Family Medicine (LHV) accepted new guidelines on availability and accessibility. Insurers offered € 4,- for each patient when the guidelines were met. Practices should minimally be open 6 h a day, 5 days a week and address emergency calls by a medically trained person within 30 s. The GP had to visit the emergency patients within 15 min. It was incentivized but also checked by the Dutch Inspection of Health Care and subsequent failure to meet the standard was financially penalized (in practices of > 2500 patients over € 10.000, - could be missed). Only 3 practices finally did not meet the target. (personal communication L. Rijkers, LHV)

- A 5 year extensive project to renew the FM-training including training the trainers was completed in 2006 with a focus on assessing and improving consultation skills. The vocational training program of GPs involved ± 1600 trainers and ± 3000 trainees. Nearly half of the GP-population thus got extra education in communication and in treating according to clinical guidelines in a new curriculum of 8 days every year.