A new contract for Danish general practice
By Ynse de Boer
At the end of 2011 the Danish Organization (PLO) and the Danish Regions finally agreed on a new contract. The negotiations had been going on for about 3 years.
The new contract is interesting from a quality improvement perspective:
- All GP’s are to include the data capture program before the end of 2012.
- All GP’s are expected to start using ICPC codes for chronic diseases from the 1st of April 2011.
- GP’s should start reporting quality data for diabetes, heart failure, IHD, stress, anxiety en depressive disorder, as soon as they are connected to the data capture system.
- All practices should perform some kind of patient evaluation survey every 3 years.
- The developmental parts of the central Danish Quality Unit DAK-E has been cut away
Furthermore it is agreed, that a Danish Quality model for General Practice should be developed, and be ready for pilot test in autumn of 2011. This task is gives to the Danish Institute of Quality and Accreditation in Healthcare (IKAS; http://www.ikas.dk/English.aspx). The chosen standards and indicators are inspired by different existing indicator sets, and should include indicators on health performance, organizational issues and patient satisfaction. Indicators on health performance are almost ready and can be collected by the data capture program. The patient evaluation tool (much like Europep) still needs some adjustments, and there is ongoing work with choosing and customising the organizational indicators.
In the future general practice will be accredited, as hospitals already are today.
It yet has to be decided, in what way participating practices can be assisted and supported in working with quality plans and feedback.
The Danish Organization and especially the Danish Regions have the impression that research, CME and QI-activities shuld be integrated in order to support and inspire each other better. Until now there have been 3 separate funds to support GP activities in these areas, and it is decided to analyse in what way the funds can be integrated.
Especially the Danish Regions have been unsatisfied with the number of practices that have implemented the data capture program and other QI initiatives. They have decided, they want to concentrate resources in QI and CME on broader implementation of the use of ICPC-coding, indicator reporting through the data capture model, and stimulation of GP’s on reflecting on and working with quality reports in areas where sets of indicators for family medicine have been developed (e.g. diabetes, COPD, IHD,..).
In this process, unfortunately, the funding of the Central Quality Unit (DAK-E) has been reduced. As a consequence the Unit will have to focus on maintaining and supporting the data capture model, and there are limited resources for developing indicators in new areas. Until now this work has been done in DAK-E, and there yet is no organisation, that can take over.
To conclude: There is a very good opportunity for spreading known and respected methods of QI, but there is a need to establish a new structure that can inspire and develop new areas and new methods.