Guiding opinions on the general practitioner system

First, fully understand the importance and necessity of establishing a general practitioner system.

(A) the establishment of a general practitioner system is an urgent need to protect and improve the health of urban and rural residents. China is a developing country with a population of over 65.438+300 million. With the development of economy and the improvement of people's living standards, urban and rural residents have higher and higher requirements for improving their health. At the same time, the changes of industrialization, urbanization and ecological environment have brought more and more factors affecting health, and the aging population and the changes of disease spectrum have also put forward new requirements for medical and health services. General practitioners are highly integrated medical talents who mainly undertake integrated services such as primary preventive health care, diagnosis, treatment and referral of common and frequently-occurring diseases, patient rehabilitation, chronic disease management and health management, and are called "gatekeepers" of residents' health. Establishing a general practitioner system and giving full play to the role of general practitioners are conducive to comprehensively implementing the policy of putting prevention first and making medical and health services better serve people's health.

(2) The establishment of general practitioner system is an objective requirement to improve the level of primary medical and health services. Strengthening primary medical and health work is the focus of medical and health reform and development, and the basic way to improve the fairness and accessibility of basic medical and health services; Medical and health personnel are the key to determine the level of primary medical and health services. Over the years, the construction of grassroots medical and health talents in China has lagged behind, and the number of qualified general practitioners is seriously insufficient, which has restricted the improvement of grassroots medical and health services. Establishing a general practitioner system and training a large number of qualified general practitioners who can get down, stay and use well are the objective requirements and the only way to improve the level of primary medical and health services.

(3) The establishment of general practitioner system is an important measure to promote the transformation of medical and health service model. It is the development direction of medical and health services in China, and it is also the common practice and successful experience of many countries to establish a graded diagnosis and treatment model, implement general practitioner contract service and implement the responsibility of medical and health services to individual doctors. Establishing a general practitioner system suitable for China's national conditions is conducive to optimizing the allocation of medical and health resources, forming a reasonable division of labor between primary medical and health institutions and urban hospitals, providing sustained, coordinated and convenient basic medical and health services for the masses, and alleviating the situation that it is difficult and expensive for the masses to see a doctor.

Second, the guiding ideology, basic principles and overall objectives of establishing the general practitioner system

(4) guiding ideology. According to the general idea of deepening the reform of medical and health system, adapting to the stage of China's economic and social development and the changing trend of residents' health needs, we should adhere to the basic path of ensuring basic health, strengthening grassroots units and building mechanisms, follow the laws of medical and health development and general practitioner training, strengthen the leading role of the government in basic medical and health services, pay attention to the role of market mechanisms, base ourselves on basic national conditions, learn from international experience, adhere to institutional innovation, gradually establish and improve the training, use and incentive system of general practitioners with China characteristics, and comprehensively improve grassroots units.

(5) Basic principles. Adhere to practice, pay attention to quality, focus on improving clinical practice ability, standardize training mode, unify training standards, strictly access conditions and qualification examinations, and effectively improve the training quality of general practitioners. Adhere to the innovation mechanism, serve health, reform the practice mode of general practitioners, establish and improve the incentive mechanism, guide general practitioners to practice at the grassroots level, and gradually form a grassroots medical and health team with general practitioners as the main body to provide safe, effective, convenient and cheap basic medical and health services for the masses. Adhere to the overall design, step by step implementation, focus on the long-term, strengthen the overall design, and gradually establish a unified and standardized general practitioner system; Based on the current situation, we should train general practitioners through multiple channels to meet the needs of general practitioners at the grassroots level at this stage.

(6) the overall goal. By 2020, China will initially establish a dynamic general practitioner system, and basically form a unified and standardized general practitioner training model and a service model of "first diagnosis at the grassroots level". General practitioners will basically establish a relatively stable service relationship with urban and rural residents, basically achieve 2-3 qualified general practitioners per 10,000 urban and rural residents, and the service level of general practitioners will be comprehensively improved, basically meeting the basic medical and health service needs of the people.

Third, gradually establish a unified and standardized general practitioner training system.

(7) Standardize the training mode of general practitioners. Gradually standardize the training of general practitioners into "5+3" mode, that is, first receive five years of undergraduate education in clinical medicine (including Chinese medicine) and then receive three years of standardized training of general practitioners. During the transition period, the three-year standardized training of general practitioners can be implemented in two ways: "standardized training after graduation" and "postgraduate education in clinical medicine", and the specific ways are determined by the provinces (autonomous regions and municipalities).

After graduation, the personnel participating in standardized training are mainly recruited from graduates of clinical medicine with bachelor degree or above. During the training period, the standardized training base for general practitioners will be managed under the guidance of health departments (including Chinese medicine management departments) and education departments. Postgraduates majoring in clinical medicine in general practice are trained according to the unified requirements of standardized training for general practitioners, and those who pass the examination after the training can obtain the standardized training certificate for general practitioners; Postgraduate education in clinical medicine is mainly managed by the education department.

(eight) to unify the standardized training methods and contents of general practitioners. The standardized training of general practitioners is mainly to improve the clinical and public health practice ability, which is carried out in the standardized training base of general practitioners recognized by the state, and the tutorial system and credit system management are implemented. Participants rotate in the clinical department of the training base and the public health and community practice platform. In principle, the rotation training time of designated departments in clinical training bases should not be less than 2 years, and in addition, some time should be arranged for business training in grass-roots practice bases and professional public health institutions. After the training base organizes the examination according to the national standards, those who meet the requirements of diseases, cases, basic clinical ability, basic public health practice ability and professional quality and obtain the required credits can obtain the certificate of standardized training for general practitioners. The specific contents and standards of standardized training are formulated by the Ministry of Health, the Ministry of Education and state administration of traditional chinese medicine.

(nine) to standardize the management of personnel participating in the standardized training of general practitioners. The personnel who participate in the standardized training of general practitioners are part of the residents in the training base. Enjoy the treatment of residents in the training base during the training period, and give financial subsidies according to different situations. Among them, those with postgraduate status shall implement the relevant provisions of the current national postgraduate education; Selected by the work unit, the relationship between personnel and wages remains unchanged. There is no training (learning) fee during the standardized training period, and the training fee beyond the standard credits and the specified time is borne by the individual. Specific management measures shall be formulated separately by Ministry of Human Resources and Social Security, Ministry of Health, Ministry of Education and Ministry of Finance. (10) unifying the practice conditions of general practitioners. In the standardized training stage of general practitioners, students can engage in clinical work such as medical examination, disease investigation and medical treatment under the guidance of tutors, participate in hospital duty, and participate in the national doctor qualification examination as required. Registered general practitioners must pass three years of standardized training for general practitioners to obtain qualified certificates and pass the national doctor qualification examination to obtain medical qualifications.

(eleven) unified general medical professional degree awarding standards. With a five-year bachelor's degree or above in clinical medicine, those who have passed the standardized training of general practitioners and meet the requirements of the national degree are awarded the corresponding professional degree in clinical medicine (general practice). The specific measures shall be formulated by the Academic Degrees Committee of the State Council and the Ministry of Health.

(twelve) improve the basic education of clinical medicine. The undergraduate education of clinical medicine should focus on cultivating basic knowledge and basic ability of basic medical theory, clinical medicine and preventive medicine, and at the same time strengthen the theoretical and practical teaching of general medicine, focusing on cultivating doctor-patient communication, the use of essential drugs and the management of medical expenses.

(thirteen) the reform of clinical medicine (general direction) professional degree graduate education. From 20 12, the newly recruited clinical medical graduate students (general practice direction) will be trained according to the requirements of standardized training for general practitioners. It is necessary to adapt to the post requirements of general practitioners, further strengthen the training ability of clinical medical graduates, and gradually expand the enrollment scale of clinical medical degree graduates in general medicine.

(fourteen) to strengthen the continuing education of general practitioners. Focusing on the new knowledge and skills in the development of modern medical technology, we will strengthen the regular, targeted and practical continuing medical education for general practitioners. Strengthen the assessment of continuing medical education for general practitioners, and take the participation in continuing medical education as an important factor in the employment of general practitioners, promotion of technical positions and re-registration of practicing qualifications.

Four, the recent multi-channel training of qualified general practitioners

In order to solve the contradiction between the urgent need for general practitioners at the grassroots level and the long period of standardized training for general practitioners, various measures should be taken in the near future to strengthen the training of general practitioners, and strive to have qualified general practitioners in every urban community health service institution and rural township health centers by 20 12.

(fifteen) vigorously carry out on-the-job training for primary doctors. For qualified grass-roots in-service practicing doctors or assistant practicing doctors, job-transfer training will be conducted for 1-2 years as needed. Job transfer training is mainly to improve the basic medical and public health service ability, and it is carried out in the standardized training base of general practitioners recognized by the state. After the training, he passed the unified examination organized by the provincial health administrative department and obtained the qualification certificate of general practitioner transfer training, which can be registered as a general practitioner or an assistant general practitioner.

(sixteen) to strengthen the skills training of general practitioners. Appropriately increase the training of clinical skills and public health practice time for five-year clinical medical students at the grassroots level. Three-year medical graduates who work in economically underdeveloped rural areas can be registered as assistant general practitioners after two years of clinical skills and public health training in nationally recognized training bases, but the health administrative departments of provinces (autonomous regions and municipalities) should strictly control the proportion.

(seventeen) to improve the academic level of primary doctors. Grassroots doctors are encouraged to improve their academic level by participating in adult higher education, and take the corresponding examination for practicing doctors after meeting the requirements. Those who pass the examination can be registered as general practitioners or assistant general practitioners according to procedures.

(eighteen) to encourage hospital doctors to serve at the grassroots level. Strictly implement the cumulative service 1 year for urban hospital doctors to promote the title of attending physician or deputy chief physician to the grassroots level, and the health department should do a good job in organization, management and assessment. Establish and improve the counterpart support system and two-way communication mechanism between urban hospitals and primary medical and health institutions. Hospitals at or above the county level should strengthen technical guidance and training at the grassroots level through telemedicine and distance teaching. It is necessary to formulate management measures to support hospital doctors (including retired doctors) to provide services to grassroots medical and health institutions (including medical institutions organized by social forces such as private clinics) in various ways and get reasonable remuneration.

Fifth, reform the practice mode of general practitioners.

(nineteen) to guide general practitioners to practice in various ways. General practitioners who have obtained the qualification for practice generally register 1 practice quota, and can also register more as needed. General practitioners can work full-time or part-time in primary medical and health institutions (or hospitals), or they can independently run individual clinics or jointly run partnership clinics with others. Encourage the formation of a general practitioner team composed of general practitioners and community nurses, public health doctors or rural doctors to provide services to residents. It is necessary to improve the human resources management measures of basic medical and health institutions for general practitioners and standardize the labor relations management of employees in individual clinics.

(20) The government provides a service platform for general practitioners. For general practitioners (including specialists in large hospitals) working at the grass-roots level, grass-roots medical and health institutions organized by the government should provide service platforms for them by signing agreements. It is necessary to fully rely on existing resources to set up regional medical inspection and testing centers, encourage and standardize the development of social retail pharmacies, and provide conditions for the practice of general practitioners.

(twenty-one) to implement the contract service relationship between general practitioners and residents. Grassroots medical and health institutions or general practitioners should sign a service agreement with residents for a certain period of time, establish a relatively stable contractual service relationship, and implement the service responsibility to individual general practitioners. The insured can choose their own contracted doctors within the designated medical insurance service institutions or general practitioners in counties (cities, districts), and can renew their contracts or choose another contracted doctor after the expiration. Health administrative departments and medical insurance agencies should sign agreements with designated service institutions or doctors according to the insured's independent choice to ensure the implementation of the service agreement between general practitioners and residents. With the improvement of the general practitioner system, the number of contracted services for each general practitioner will be gradually controlled at around 2,000, with a certain proportion of special groups such as the elderly, the chronically ill and the disabled.

(twenty-two) actively explore the establishment of graded medical care and two-way referral mechanism. Gradually establish a graded medical management system for primary diagnosis, and clarify the admission standards and two-way referral mechanism of hospitals at all levels. Conditional areas, first carry out the pilot of the first diagnosis of general practitioners, and gradually implement it. Ministry of Human Resources and Social Security and the Ministry of Health should formulate policies and measures to encourage two-way referral, and list the implementation of two-way referral and graded medical care in designated medical institutions as assessment indicators, and the assessment results are linked to medical insurance payment.

(twenty-three) to strengthen the supervision of the service quality of general practitioners. The administrative department of health shall strengthen the supervision of the management and service quality of the practice registration of general practitioners. Health departments and medical insurance agencies should establish an assessment system with service quantity, service quality and residents' satisfaction as the main indicators, and conduct strict assessment on general practitioners. The assessment results will be published regularly and linked to the payment of medical insurance and the allocation of funds for basic public health services.

Sixth, establish an incentive mechanism for general practitioners.

(twenty-four) charge service fees according to the number of contracted services. General practitioners provide contracted residents with agreed basic medical and health services, and charge annual service fees. The service fee is shared by the medical insurance fund, the basic public health service fund and the contracted residents. The specific standards and scope of protection are determined by local governments according to the local medical and health service level, contracted population structure, basic medical insurance fund and public health fund affordability. On the basis of fully considering the acceptance of residents, different service fee standards can be implemented for different groups of people. All localities should determine the service content and service fee standards of general practitioners, and combine them with the overall planning of medical insurance clinics and the reform of payment methods.

(twenty-five) regulate the fees for other medical treatment of general practitioners. General practitioners shall provide the contracted residents with the agreed basic medical and health services, and shall not charge other fees except the contracted service fees as required. General practitioners can provide non-agreement medical and health services according to the application of contracted residents, and charge fees according to regulations; Outpatient service can also be provided to non-contracted residents, and service fees such as general medical treatment fees can be charged according to regulations. The outpatient expenses within the insurance policy can be paid according to the provisions of medical insurance. Gradually adjust the charging standard of diagnosis and treatment services to reasonably reflect the technical service value of general practitioners.

(twenty-six) reasonably determine the labor remuneration of general practitioners. General practitioners and their team members who belong to the official staff of grass-roots medical and health institutions organized by the government shall be paid according to state regulations; Other general practitioners who work at the grass-roots level get paid according to the service contracts signed with grass-roots medical and health institutions and the service agreements signed with residents, or they can get paid by providing outpatient services to non-contracted residents. The distribution of internal performance pay in primary medical and health institutions can be tilted towards general practitioners and other personnel who undertake clinical frontline tasks by setting general practitioner allowances. Performance appraisal should fully consider the number and composition of residents contracted by general practitioners, outpatient workload, service quality, residents' satisfaction and the control of residents' medical expenses.

(twenty-seven) improve the subsidy policy and encourage general practitioners to work in hard and remote areas. General practitioners working in grassroots medical and health institutions organized by the government in hard and remote areas enjoy allowances in hard and remote areas in accordance with state regulations. For general practitioners who practice independently in sparsely populated, hard and remote areas, local governments should formulate preferential policies or give necessary subsidies, and the central and provincial finances should be appropriately inclined when arranging transfer payments.

(twenty-eight) to broaden the career development path of general practitioners. Encourage local governments to set up special posts in accordance with relevant regulations and recruit outstanding professional and technical personnel to work in primary medical and health institutions. After standardized training, general practitioners can apply for promotion to primary medical and health institutions one year in advance, and under the same conditions, general practitioners can be given priority. It is necessary to take the number of contracted residents, the number of consultations, the quality of service and the satisfaction of the masses as important factors for the promotion of the title of general practitioner. The promotion of general practitioners' titles in grass-roots units can relax foreign language requirements in accordance with relevant state regulations, and there is no rigid requirement for papers. Establish a mobile mechanism for primary medical and health personnel, and encourage general practitioners to move in two directions between county-level hospitals and primary medical and health institutions. When enrolling students in a specialized training base, general practitioners with practical experience at the grass-roots level are given priority under the same conditions.

Seven. Related safeguard measures

(29) Improve relevant laws and regulations. On the basis of full argumentation, we will promote the revision of the Law on Medical Practitioners and related laws and regulations, improve the conditions for the qualification of doctors, clarify the scope of practice, rights and responsibilities of general practitioners, and protect the legitimate rights and interests of general practitioners. To study and formulate measures for the management of doctors' multi-point practice, clarify the career development policy of freelancers, guide hospital doctors to provide services at the grassroots level, and encourage retired doctors to practice in primary medical and health institutions.

(thirty) to strengthen the construction of general practitioner training base. On the basis of making full use of existing resources and according to the principle of "filling vacancies", we will build a general practitioner training network with tertiary general hospitals and conditional secondary hospitals as clinical training bases and conditional community health service centers, township hospitals and professional public health institutions as practice bases. The government gives necessary support to the construction of standardized training base for general practitioners and teaching practice activities; The central government gives subsidies to areas with financial difficulties. The Ministry of Health shall, jointly with the Ministry of Education and other relevant departments, formulate the construction standards and management measures for clinical training bases and practice bases. Strengthen the construction of general practice teachers, formulate standards for general practice teachers, build regional general practice teacher training bases based on qualified medical colleges, and focus on supporting teacher training in grassroots practice bases.

(thirty-one) reasonable planning of the training and use of general practitioners. The state plans the training of general practitioners in a unified way, announces the list of training bases for general practitioners and the number of enrollment places every year, and the enrollment is inclined to the central and western regions. The health administrative departments of all provinces (autonomous regions and municipalities) should co-ordinate the needs of general practitioners in this province (autonomous regions and municipalities) and announce the positions of general practitioners in counties (districts). Guided by the post demand of doctors, scientifically regulate the enrollment scale of clinical medicine specialty. The Ministry of Health should formulate a national doctor post demand plan, and the Ministry of Education should make a good connection with the doctor post demand plan when formulating the enrollment plan for clinical undergraduate and clinical graduate students.

(thirty-two) give full play to the role of relevant industry associations. Strengthen the capacity building of relevant industry associations, and fully rely on industry associations (societies) to play an advantage and positive role in industry self-discipline and general practitioner training content, standards, processes, and general practitioner qualification examinations.

Eight, actively and steadily promote the construction of general practitioner system.

(thirty-three) to strengthen organizational leadership. The people's governments of all provinces (autonomous regions and municipalities) shall formulate the implementation plan of this province (autonomous regions and municipalities) as soon as possible according to the spirit of this guidance. Health, education, human resources and social security, finance, traditional Chinese medicine, legal system and other departments should organize the revision and improvement of existing laws and regulations as soon as possible and formulate relevant implementation rules.

(thirty-four) to carry out pilot promotion. The establishment of the general practitioner system is an important reform of the current doctor training system, doctor practice mode and medical and health service mode, with strong policy, wide coverage and far-reaching influence. For the difficult problems in the reform, local governments are encouraged to pilot first and actively explore. Relevant departments should sum up practical experience in a timely manner and gradually promote it. It is necessary to strengthen the convergence of policies and measures, study new situations and problems in time, and ensure the steady implementation of the general practitioner system. (thirty-five) do a good job in publicity and guidance. Through health education, publicity and other means to cultivate residents' concept of preventive health care, guide residents to change their traditional concept and habit of seeking medical treatment, enhance the contractual awareness of the whole society, and create a good environment for the implementation of the reform.

the State Council