Quelles solutions pour la garde en médecine générale? - KCE

KCE Reports 1771
• The GP
By joining the ssystem
of the GP Circle that transfe ers the duty to a hospital,
the GP fulfills his
continuity obligation.
• The emerggency
physician
Once an emerggency
physician ttreats
a patient, th he hospital is responsible
for the respect of patients’ rightss
by the physician n. Regarding proffessional
medical malpraactice,
civil liabilityy
depends on the legal l relation betwween
the
hospital and thhe
emergency phhysician.
Some medical m malpractice
acts,
can also be qqualified
as a ccriminal
act, whic ch is always peersonally
imputable.
3.2.3. Adapttation
of the currrent
legal framew work
For the first opttion,
data show (ccf.
4.1.4) that durin ng deep night the number
of calls is arouund
1 to 2 per 1100
000 inhabitan nts, whereas thee
current
legislation requuires
1 permanenntly
available GP per 30 000 inhaabitants.
Legislation should
be adapted too
align the require ed number of GPss
on call
to the expectedd
number of calls.
For the second option: if the patiients
systematically
consult the emmergency
services, the coontinuity
of medicaal
care is assured d and an adaptatioon
of the
regulation is noot
necessary.
However the ttriage
system muust
be included in the legislationn.
If this
system is outsoourced
to the 17333
system, the legislation
must be aamended
as foreseen in sscenario
1..
3.2.4. Redeffinition
of the tassks
of the involv ved institutions
Today the emeergency
services do not fall under r the responsibilitty
of the
GP Circles. Howwever
collaboratioon
agreements ca an be concluded too
further
determine the rresponsibilities.
3.2.5. Issuess
to consider in case of impleme entation
Some critical points need analyzed if one
would considder
the
implementation of a collaborationn
between circle and a ED:
• Outsourcinng
the duty to emeergency
services might lead to an ooverload
of these seervices;
• Solutions ( (e.g. home visits) ) are needed for the patients who are not
able to go tto
the emergencyy
service (e.g. nurs sing homes);
Affter-Hours
Primaary
Care
• The costs annd
financial implic
costs are highher
but they are ru
• There is not yyet
a clear answer
and the hospital.
33.3.
Scenario 3: Consultatio
« Walk–In Centress
» (WIC) in the U
• generally opeen
every day ;
• located on eaasily
accessible pla
• advice and treeatment
of minor
• generally mannaged
by nurses
WWould
that solution
be possible in B
33.3.1.
Legal annd
deontological
33.3.1.1.
Legal frame
In
Belgian Law, thhe
competences
221quinquies
of thee
Royal Decree n
the
Royal decree oof
18 June 1990.
FFurthermore,
thes
mmeet
the certain q
A list of specific te
inn
emergency me
nnot
(yet) possible
pphysicians.
33.3.1.2.
Deont
TThere
is no Orde
hhave
drafted a c
ssanctioning
comp
ppractices
guideline
33.3.1.3.
Comp
• Sanctions for
acts without
conditions.
1
cations for the h
unnning during de
r regarding the lia
n by nurses
UK offer a direct ac
aces ;
illnesses and inju
Belgium ?
l frame
of the nursing st
n° 78
se competences c
ualifying condition
echnical services
edical services. A
e in Belgium, as
tological frame
er of Nurses. Five
code of ethics, b
petences, this co
e ».
petences and res
eseen by the Roy
the necessary
17 ealthcare systemm
(ED
eep nights anywayy).
ability of the GP CCircles
ccess to healthcare
:
ries ;
aff is limited by aarticle
and are lissted
in the annexxes
of
9
can only be perfformed
by nursess
who
ns and execution modalities.
has been set up for nurses speciaalized
An implementationn
of walk-in-centrres
is
s many medical acts are reserveed
to
e professional orgganizations
for nurses
but in the absennce
of controllingg
and
ode is only connsidered
as a « best
sponsibility
yal Decree n° 78 in case of performing
competences orr
without fulfillingg
the
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