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KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 123
the issue of team-working is difficult for the GP profession because it entails a struggle
between two important values: autonomy and team-work.
The leavers’ study confirmed that group practice is not such a magic bullet : the loss of
autonomy when working in group practice can also be a reason why some general
practitioners leave the profession.
7.4.2 Suggested policies to improve the working conditions in general practice
The best ranked policies in the stakeholders’ survey were supporting a career with new
professional opportunities and scrapping the individual on-call obligation. However, the
stakeholders gave them rather low score in comparison with other policies. The reason
might be that new professional opportunities (like teaching and research) are regarded
as feasible for those working in a group of GPs, in order not to jeopardize the
continuity of care and the accessibility of the practice. Thus, this comes as no surprise
that encouraging the GPs to work in group (a policy initially considered under the
health system organization heading) was among the most supported policies in the
stakeholders study). Indeed, team-working does not only make possible to have other
professional responsibilities but also to delegate administrative tasks to assistant staff
and to get access to Information Technologies infrastructure whose cost is prohibitive
for GPs working in solo practice. It also allows the GP to have a more active role in a
multidisciplinary team work that allows the GP to get a stronger role for instance in the
care for chronic patients and frail elderly patients. Also, GP students were very keen
with the idea of having a practice support staff although it was unclear whether they
understood that this support staff was linked to the work in a group-practice.
Removing the individual obligation for on-call duties and replacing it by deputizing
services showed to be controversial measures. Most stakeholders agreed that these
policies were good for attracting and retaining GPs but they bothered about their sideeffect
particularly on accessibility and on cost for the health care system. Moreover, the
profession itself seems to be divided on that topic. GP students were quite in favor of a
deputizing service and GP leavers also raised this idea as a policy that would have made
their life easier. But it was not clear, according to the GP stakeholders, whether the
on-call duties obligation should be scrapped. This is a paradox: work-life balance is
jeopardized by the individual on-call duty but GPs stakeholders are not so keen to scrap
it. A reason could be that by calling public authorities into rescue for organizing deputy
services, the profession risks loosing its current grasp on-call service through the GP
"cercles/kringen". Scrapping individual on-call obligation will thus transfer the
responsibility to another –possibly governmental- body and, hence, affect the
profession's autonomy at the local level.
7.5 HEALTH SYSTEM ORGANIZATION
It is impossible to disconnect the issues addressed in this report from the other
domains of the health system organisation. GPs’ drop-out from family medicine is
observed in many OECD countries and there are some indications that the role of the
GP within the health care system can be improved. Indeed, the literature review
concluded that the place and organization of primary healthcare, as well as the role of
GPs within the health care system may influence indirectly physician supply and
therefore the shape, the relevance and feasibility of attraction-recruitment-retentionpolicies.
For example, some health care systems do allow for an improved role of a
physician assistant or nurse practitioner, allowing the GP to have less administrative
tasks to carry on. Belgium is considered as a country with a low level of professional
collaborative relationships compared with other European countries. Care integration
(kind and magnitude of the links between the different health care actors) is the key
issue to which we now turn.
The health system organization policies got high scores among stakeholders study, much
higher than financing or work-life balance policies. This suggests that the stakeholders
are aware of the fact that GP attraction and recruitment is linked to the organisation of
the Belgian health care system. In general, they were very keen but cautious with these
kinds of policies. They supported policies favoring group practice including the