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102 Making General Practice Attractive: Encouraging GP attraction and Retention KCE Reports 90 the accessibility of care. But they scored less in terms of cost-benefit and acceptance by other health professionals. The stakeholders were thus less keen with increasing fees because they feared that higher fees would mean higher out-of–pocket expenses for the patients, thus less accessibility. Conversely, target payment and incentives for underserved area had a good score from a cost-benefit point of view but only the latter was good at granting sufficient accessibility. This last one had an average score on attraction and performed less well on cost-benefit. This figure shows that, for financing policies, the stakeholders face some trade-off, particularly between attraction and accessibility, and between attraction and cost-benefit. Figure 3: Criteria of financing policies: radar by policy When prompted for other financing policies, stakeholders made suggestions confirming previous policies or policies included in the organisation topic (see below). Administrative work should be lowered (revision of the “nomenclature”) and quality of medical work must be improved by a better organisation between members of the profession The patient is always a major preoccupation: he has not to carry the cost of improvements. GP’s social status in general and his financial security were also mentioned. 6.6.2.3 Work-life balance policies The support of a career with new professional opportunities is the most important policy according to the stakeholders. This item got a mean rank of 1.91 (Table ). The second most important policy is the suppression of the individual duty obligation with a mean rank of 2.1. Note, however, that the range of the scores for this topic was quite reduced: all policies fall in a very short interval of less than half a point (between 4.3 and 4.7) and that none of them has a score above 5. They overall positive effect is thus quite mixed.
KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 103 Table 18: Preferred work-life balance policies: mean ranks and scores (n=102) Most preferred work-life balance policies Mean Mean rank score 1. Support an evolving career 1.91 4.69 2. Suppression of the individual duty obligation of on-call 2.10 4.48 3. Not to penalize work with regular schedules 2.23 4.40 4. Compensate GPs for their continuous teaching activities 2.83 4.17 5. Groups of professional GPs for on-call 3.01 4.26 The respondents made positive open-ended comments about evolving career: it will make their work more diverse, allow them to meet specialists, improve the link between teaching and practice, and allow for taking a break and thus avoiding burn-out. Suggested improvements concern the group of women who should be the special target of this policy. Some interviewees notice that new professional activities are only feasible for those working in group where colleagues can assure the continuity of care. This policy should also concern the possibility to do preventive health care activities without being penalized. The risks that lie behind this policy are the decrease of practicing and consequently of available GPs as well as their decreased knowledge of the profession that is linked to the number of acts. The most discarded policy is the setting-up of professional groups of GPs for on-call duties (mean rank 3.01 and mean score 4.26). This policy triggers bipolar comments. The positive ones refer to the experience in France and see this suggestion as interesting for the training of the young GPs. The negative comments put the emphasis on the patient’s confidence in his/her GP and on the fact that the GP on duty will not know the patients (“mercenaries” was the term used). It would be better to organize duty and replacement between local GPs. Supporting an “evolving” career and allowing GPs to have regular working schedules were only positive for the attractiveness (Figure 4: Criteria of work-life balance policies: radar by policy.). The reason could be that the stakeholders do worry that those measures would jeopardize the accessibility of care.
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