Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
regarding tthe
organization oof
a unique call sy ystem and urgent medical
care.
• The scenario
1733 with the possible decision ns that can be takken
must
be integrated
in legislation;
• A bill has bbeen
submitted too
develop a unifor rm call system forr
the GP
on duty :
o for thee
extension of the legal frame for creating
call centress,
o foreseeing
an eventual triage of the medical
care by a thirdd
party,
o foreseeing
strict procedures
for the triage e.
• Protocols ( (validated by scientific
organization ns) will be set up bbetween
the 1733-eemployer
and GPP
Circles. They are a important to support
telephonistt’s
decision, to ccover
their liabilit ty and the physician
on
duty’s onee.
The protocols must also form m a bridge between
the
emergencyy
services and thee
GPs.
• A protocol between the 17733
employer an nd the FPS mustt
further
determine the training / educcation
of the telep phonists.
• Article 9 of
the Royal Decree
n° 78 could be b amended: in pparticular
the notion of “provision of after-hours care in hospitals or aat
home”
could be aadapted
(“in hosppitals
and ambula atory setting”) so that the
GP surgeryy
would be mentiooned
instead of the
patient’s home.
• An amenddment
of the artticles
of the Penal
Code regardding
the
culpable ommission
is not neccessary
as the continuity
of medicaal
care is
assured if the physician joinns
the GP on duty y service. The liabbility
will
be coveredd
by the triage sysstem.
• Although a uniform start and
ending time of o the duty period
is not
obligatory iin
Belgium, this coould
also be oppo ortune.
3.1.3. Redeffinition
of the tassks
of the involv ved institutions
In the current legislation the finnal
responsibility is left to the GP Circles,
with a superviising
role for thee
Provincial Med dical Commissionns.
This
system is not feeasible
if the triagge
is performed by y a telephonist that
is out
of the GP circlee.
In a triage systtem,
this system itself is responsi ible for the triagee
and its
optimal functionning
relies on a cloose
collaboration with the circles. HHowever
Affter-Hours
Primaary
Care
these
circles remaain
responsible foor
the organization
of the GP duty once
the
telephonist hass
transferred a deemand
for medical
care.
33.1.4.
Issues too
consider in casse
of implementtation
SSome
critical points
need to bee
reflected on if f one would connsider
immplementation
of this scenario.
• Telephonists do not systematically
have a knoowledge
of the GGP
on
duty’s time sschedule
and workload:
they cannnot
inform the patient
about possiblee
waiting times.
• How would the
patient know whhen
he/she can viisit
the GP or wheen
the
GP will visit thhe
patient? 3 posssibilities:
o definition of the waiting timme
and service levvel
agreement witth
the
physiciann
to define this timme
period ;
o the telephonist
can fix an appointment for the patient or traansfer
the patiennt
to the secretaryy
of the waiting poost
;
o recordingg
of the dispatchhing
of the sociaal
taxi and the mmobile
physiciann
to give the patiennt
an estimation oof
the waiting timee.
• Problematic teechnical
aspects oof
1733
WWhat
if the patieent
does not knoow
his/her ZIPcodde?
Ther would be a
pproblem
to determmine
the competeent
circuit and thee
competent provvincial
1100
services. Thee
caller ID could bbe
used for mobile
phone numberrs
but
wwho
will bear the ccosts
?
• Shortage of ppersonnel
In
the above menntioned
bill, telephhonists
should haave
a bachelor nuursing
ddegree
and shouldd
have followed aadditional
50 hourss
of specific education.
TThese
requiremennts
tend to makee
the current shoortage
of nursing staff
wworse.
Another ooption
is to enlist
paramedical peersonnel
in the RRoyal
DDecree
n° 78.
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