I. General requirements
(1) general idea. In accordance with the national and provincial arrangements and requirements for deepening the reform of the medical and health system, around the goal of building a healthy province and realizing basic medical and health services for all, we will persist in taking safeguarding people's health as the center, vigorously promote the downward shift of the focus of medical and health work and the sinking of resources, and speed up the signing service of family doctors in combination with the implementation of the graded diagnosis and treatment system and the construction of the general practitioner system. Constantly enrich and standardize the content of contract signing services, highlight the integration of traditional Chinese and western medicine, and enhance the people's willingness to sign contracts; Establish and improve the internal incentive and external support mechanism of contract service, and mobilize the enthusiasm of family doctors to carry out contract service; Strengthen the construction of family doctors and provide talent guarantee for contract service; Improve the top-down linkage mechanism, promote the first diagnosis and graded diagnosis and treatment at the grassroots level, provide comprehensive, sustained and coordinated basic medical and health services for the masses, and enhance the people's sense of gain.
(2) Work objectives. On the basis of comprehensively promoting the contracted service of family doctors, by the end of 20 17, the coverage rate of contracted service of family doctors in the whole province will reach over 15%; The coverage rate of contracted services for key groups such as the elderly, pregnant women, children and the disabled, and patients with chronic diseases such as hypertension, diabetes, tuberculosis and severe mental disorders has reached more than 30%. By 20 17, the province has basically established a family doctor contract service system with clear objectives, clear contents, standardized services and supporting policies. The coverage rate of family doctors' contracted services is over 30%, and the coverage rate of key people's contracted services is over 60%. By 2020, we will strive to expand the contract service to the whole population, form a long-term and stable contract service relationship, and basically realize the full coverage of the family doctor contract service system.
Second, the task
(A) a clear contract service subject
1. Make it clear that the family doctor is the first person responsible for contracting services. The contract service of family doctors is mainly provided by government-run primary medical and health institutions, supplemented by other forms. At present, family doctors mainly include registered general practitioners (including assistant general practitioners and Chinese general practitioners) in primary medical and health institutions, as well as competent doctors and rural doctors in township hospitals. Actively advocate qualified in-service clinicians and retired clinicians, especially internal medicine, gynecology, pediatrics, Chinese medicine doctors, etc. , as a family doctor to provide contract services at the grassroots level.
2. Achieve team signing service. In principle, the contract service of family doctors should take the form of team service. Family doctors are mainly composed of family doctors, community nurses and public health doctors (including assistant public health doctors), and gradually realize that each family doctor team has doctors or rural doctors who can provide Chinese medicine services. Conditional areas can recruit pharmacists, health managers, psychological counselors, nutritionists, rehabilitation therapists and social workers to join the team. Support experts and famous doctors to provide diagnosis and treatment services in primary medical and health institutions, and support hospitals above the second level to send doctors (including Chinese medicine doctors) to provide technical support and business guidance for family doctors. Family doctors are responsible for the task allocation and management of team members. Grassroots medical and health institutions should clarify the work tasks, workflow, system norms and division of responsibilities of family doctors, and carry out performance appraisal regularly. Encourage and guide residents to sign contracts nearby, and allow residents to choose a team of contracted family doctors across regions according to actual needs. Residents or families voluntarily choose 1 family doctor team to sign the service agreement, and the signing period is 1 year in principle. You can renew your contract after it expires, or you can choose another family doctor team to sign the contract.
3. Encourage portfolio signing. Encourage big city hospitals to establish consortia with county hospitals and township hospitals. Encourage urban areas to explore the establishment of a grid-connected medical service system. Encourage qualified areas to actively carry out pilot projects, and guide residents or families to voluntarily choose 1 secondary hospitals and 1 tertiary hospitals while signing contracts with family doctors. 1+ 1+ 1? Combined contract service mode, you can choose your own medical institutions according to your needs, and gradually transition to the first consultation at the grassroots level; Doctors outside the group should be referred by family doctors. Study and explore the contracted service mode of floating population to promote the equalization of basic medical and health services.
4. Encourage the establishment of family doctor clinics. Encourage individual doctors, retired medical practitioners, doctor partners and other practitioners (teams) to set up family doctor (general practice) clinics in urban and rural communities (administrative villages) in our province, and bring them into the management scope of family doctor contract service industry of county (city, district) health and family planning departments. Encourage social capital to hold primary medical and health institutions and family doctor (general practice) clinics, and support medical groups with graded diagnosis and treatment system to carry out family doctor contract services. Social capital to set up family doctor (general practice) clinics must have trained general practitioners and nurses who have obtained the qualification of general practitioners and registered the scope of general practice, and encourage the deployment of health managers, psychological counselors, nutritionists, rehabilitation therapists and other personnel. Encourage the introduction of wearable devices to monitor the health management of key populations throughout the process to meet the needs of multi-level services. Support the development of commercial health insurance and basic medical insurance, and support the needs of health management. Eligible private medical and health institutions (including individual clinics) provide contract services and enjoy the same charging and payment policies.
(2) Standardize the contents of contract services.
5. Improve and standardize the signing service. Family doctors should focus on maintaining and promoting residents' health, organically integrate basic medical services and basic public health services, and provide targeted, sustained, effective, comprehensive and personalized basic medical services, public health and agreed health management services for different groups by using residents' health records. Family doctor contract service mainly includes five aspects:
(1) Collection and management of health information. For residents who have signed service agreements, collect dynamic health information such as basic information, past medical history and recent medical information, and improve health records. According to the personal situation of the contracted residents, make a health management plan and update it in time according to the service situation.
(2) Transmission and consultation of health knowledge. Provide health consultation for contracted residents, popularize health knowledge, promote them to establish health awareness, guide them to learn and master related knowledge such as mental health, diet matching, disease prevention, guide them to deal with health emergencies, and guide them to clean their family medicine boxes regularly and use drugs rationally.
(3) Intervention and guidance of healthy behavior. Cultivate the self-health management ability of contracted residents, promote them to maintain and improve their own health, carry out health management risk assessment, take targeted intervention measures for sub-health status and bad life behaviors, and promote them to establish healthy life behaviors.
(4) Preliminary diagnosis and triage. Accept the appointment of contracted residents and provide them with basic medical and nursing services. Provide referral and triage services for medical specialties in the region and establish consultation channels.
(5) Set up family sickbeds. For contracted residents who need continuous treatment and rely on on on-site service of medical staff, family beds are set according to the admission standard of family beds.
6. Implement contract classification management. All localities should focus on the elderly, children, pregnant women, patients with chronic diseases, the disabled, high-risk groups of chronic diseases and patients with severe mental disorders, and gradually expand to other general population. In the contracting service, the target contracting population can be divided into general comprehensive health management type for the general population, health management type for people with chronic diseases with special diseases or multiple diseases, special type for women, children and the elderly, health management type for the elderly contracted for the aged care institutions and family beds for the aged at home, characteristic Chinese medicine service, rehabilitation service for the disabled contracted with rehabilitation institutions, home rehabilitation service for the severely disabled and other different types, and differentiated and personalized contracting management services can be implemented. The Provincial Health and Family Planning Commission and the Bureau of Traditional Chinese Medicine organized the formulation of family doctor contract service packages to meet the needs of different groups of people. The signing agreement of family doctors shall clarify the rights and obligations of the family doctor team and the contracted residents, and clarify the scope and content of basic medical and health services provided by the family doctor team.
(3) Establish and improve the collection, payment and performance appraisal mechanism of contracted services.
7. Improve the incentive mechanism of family doctors' income distribution. The Provincial Health and Family Planning Commission took the lead in working with the Provincial Development and Reform Commission, the Provincial Department of Finance, the Provincial Department of Human Resources and Social Security, the Provincial Bureau of Traditional Chinese Medicine and other departments to formulate guidance on the collection and payment of family doctors' contracted services in the province. Authorize the local government to work with the development and reform, finance, human resources and social security departments at the same level to determine the project connotation of the local contracted service package, as well as the personal payment and medical insurance payment standards, and standardize the contracted service behavior. The annual contract service fee for family doctors is shared by the medical insurance fund, basic public health service funds and individual contracted residents, and the local finance where conditions permit gives appropriate support. In accordance with the provisions of the medical assistance policy, the implementation of assistance. The cost of basic public health services in the contracted service is paid from the special fund for basic public health services. According to the performance appraisal results of contracted services, a certain proportion is extracted from the contracted service fee income every year, which is used as a whole for performance pay distribution, and the total amount of incentive performance pay in primary medical and health institutions is correspondingly increased. Grass-roots medical and health institutions are inclined to family doctors in the distribution of performance pay, so that family doctors can reasonably improve their income level by providing high-quality contract services. The distribution of internal performance pay in primary medical and health institutions can also adopt the method of setting up general practitioner allowance, which is inclined to those who undertake clinical frontline tasks such as family doctor contract service. In promotion and all kinds of evaluation activities, we should be inclined to the members of the family doctor team. Reasonably set the proportion of senior and intermediate positions of general practitioners in primary medical and health institutions, expand the space for promotion of professional titles, and focus on the assessment of outstanding contracted services.
8. Give play to the role of family doctors in controlling fees. Conditional areas can explore the payment of the contracted residents' outpatient fund to grassroots medical and health institutions or family doctors. For patients referred to the hospital through the grassroots, the grassroots or family doctor team will pay a certain referral fee. Explore the implementation of the division of labor mode such as the total payment of medical insurance in the vertical cooperative medical consortium, give play to the role of family doctors in the control of medical insurance payment, reasonably guide two-way referral, and play the role of gatekeeper.
9. Standardize other medical service charges. The team of family doctors shall provide contracted services for contracted residents, and shall not charge any fees other than the contracted service fees as required. Those who provide non-agreement medical and health services or provide medical and health services for non-agreement residents shall be charged in accordance with the provisions.
10. Establish a performance appraisal mechanism for contracted services. The Provincial Health and Family Planning Commission, the Bureau of Traditional Chinese Medicine, the Department of Human Resources and Social Security, the Department of Finance and other relevant departments jointly formulated and issued guidance on the performance evaluation of family doctors' contracting services in the province. Performance evaluation is mainly carried out from four dimensions: the number of contracted services, effective contracting, effective performance and service effect. The assessment results are disclosed to the public in a timely manner, and are linked to the payment of medical insurance, the allocation of funds for basic public health services and the distribution of team and individual performance. Performance appraisal indicators at all levels can be dynamically adjusted during the listing promotion stage. Establish a feedback evaluation system with contracted residents as the main body, unblock public supervision channels, and make the feedback evaluation public in time, which is an important basis for the performance evaluation of family doctors and an important reference for residents to choose family doctors. Comprehensively consider the work intensity and service quality of family doctors, and reasonably control the number of contracted services of family doctors. Establish a corresponding punishment mechanism for the team of family doctors whose assessment results are unqualified and the opinions of the masses are outstanding.
(4) Improve the up-and-down linkage mechanism.
1 1. Enhance the attraction of contract services. All grass-roots medical and health institutions should establish an appointment service system for family doctors, and contracted residents can enjoy preferential treatment and referral services when they see a family doctor at the agreed time; For contracted residents with stable illness and good compliance, the policy will be tilted in medication treatment, and the long prescription policy of 1-2 months 1 time will be implemented, so as to make a good connection between primary medical and health institutions and chronic disease specialists or comprehensive medical institutions. 40% of the drugs used by basic medical and health institutions outside the basic drug list and in the medical insurance list are mainly used to sign contracts for patients with chronic diseases, so that the drugs for chronic diseases prescribed by the insured in medical and health institutions above the second level can be provided in basic medical and health institutions in principle. Township health centers should be responsible for the adjustment service of village health stations, meet the needs of chronic diseases of rural elderly, and realize that chronic diseases do not leave the village. Give full play to the guiding role of medical insurance payment, implement differentiated medical insurance payment policies, and take measures such as continuously calculating the deductible line for eligible referral inpatients to guide residents to see a doctor at the grassroots level.
12. General practice-professional contact and cooperation. Family doctors should provide triage paths or suggestions for residents beyond the medical service capacity of their own institutions, so as to realize reasonable triage. All localities should build and improve the regional triage platform, smooth the green channel of referral between primary medical and health institutions and specialized or comprehensive medical institutions, and lead the contact and follow-up by contracted family doctors. Patients designated by family doctors to see a doctor in a specialized or comprehensive medical institution enjoy convenient services such as priority appointment, medical treatment, examination and hospitalization. All localities should gradually increase the proportion of high-quality resources and specialist sources opened by specialized or comprehensive medical institutions to local grassroots medical and health institutions. For patients transferred from specialized or comprehensive medical institutions to rehabilitation treatment and hospitalization observation in recovery period, a linkage ward is set up, and doctors from the responsibility team of specialized or comprehensive medical institutions regularly go to the linkage ward for * * * rounds to keep abreast of the rehabilitation of the transferred patients. Through linkage and cooperation, we will provide a complete and closed basic medical and health service guarantee ring for contracted residents and realize the whole process management.
13 tricyclic? Linkage integrated service system. The Provincial Health and Family Planning Commission took the lead in formulating and issuing the "Guidelines for the Division of Responsibilities of Provincial Family Doctors Contracting Service Teams" and related documents of operation procedures. All localities should guide grassroots medical and health institutions to strengthen contract signing services? A ring? Core team building (family doctor+assistant) to provide convenient and personalized health management services. Strengthen the linkage with the support system of specialized departments and auxiliary departments in the organization to form contract services? Second ring? Team, providing family bed management, team doctor consultation and other services. Establish an effective connection and linkage between general practice and specialist services, and form the responsibility of grass-roots general practice teams and specialists or specialists in general hospitals? Third ring road? Team, promote the formation of two-way referral between primary health care institutions and specialized or general hospitals. By 20 17, at least 1 county (city, district) will be selected as pilot projects at all levels. Taking the contracting service package for chronic diseases such as hypertension and diabetes as the breakthrough point, we can establish a joint clinic for chronic diseases in primary medical and health institutions, and promote the integrated service model of first consultation, graded diagnosis and treatment, and whole-course health management for contracted residents from the aspects of establishing a linkage mechanism between general practice and specialty, reforming medical insurance payment methods, and standardizing services.
(5) Strengthen the construction of family doctors.
14. Strengthen the capacity building of general practitioners. All localities should strengthen the training of general practitioners, and train general practitioners through standardized training of general practitioners, on-the-job doctor transfer training, and business cooperation of medical associations. Comprehensively carry out job skills training for family doctors, community nurses, rural doctors, etc., improve the academic level of primary medical staff and improve the knowledge structure. By 20 18, there will be more than 2 general practitioners per 10,000 permanent residents; By 2020, there will be more than 3 general practitioners per 10,000 permanent residents.
15. Implement general practitioner registration. Encourage clinical or Chinese medicine practitioners in primary health care institutions to increase the scope of general practice according to regulations; Encourage clinical or traditional Chinese medicine doctors (mainly including doctors in internal medicine, surgery, obstetrics and gynecology, rehabilitation medicine, preventive health care, traditional Chinese medicine, integrated traditional Chinese and western medicine) in urban hospitals above the second level and rural county hospitals (including traditional Chinese medicine hospitals and maternal and child health care hospitals) to participate in on-the-job training, job-transfer training or standardized training of general practitioners recognized by the Provincial Health and Family Planning Commission and the Provincial Bureau of Traditional Chinese Medicine. Those who have passed the examination and obtained the training certificate or obtained the qualifications for senior technical positions in general medicine may apply for or change their practice according to regulations.
16. Strengthen support for primary health care institutions. High and secondary medical colleges at all levels should increase their support and training for primary medical and health institutions, and incorporate qualified primary medical and health institutions into their clinical teaching and training bases. For qualified primary health care institutions, they can be used as affiliated institutions of medical colleges and universities to promote the linkage between medical colleges and primary health care institutions. Encourage qualified primary medical and health institutions to be included in standardized training bases and continuing medical education and training bases. Establish and improve the system that doctors in hospitals above the second level regularly go to the grassroots to carry out business guidance and family doctors regularly go to clinical teaching bases for further study.
(six) to strengthen the technical support of contract services.
17. Strengthen hardware support. Integrate the existing resources of medical examination, medical imaging, pathological diagnosis, blood purification institutions, disinfection supply centers and other resources in hospitals above the second level, and open them to grassroots medical and health institutions to realize regional resource sharing. All localities should give necessary support from the aspects of implementing the contract service system for family doctors, improving team building, general practice and necessary facilities and equipment configuration, and improving grassroots service capabilities. Grassroots medical and health institutions should set up a certain number of general clinics (family doctor studios) as family doctor service places according to the actual situation. In rural areas, village health stations are regarded as general clinics stationed in administrative villages by township health centers, with rural doctors as the main contracting subjects and contracted services under the guidance of township health centers.
18. Give play to the supporting role of information construction. All localities can establish and improve the family doctor information management platform based on the regional health information platform, highlight the background support function of standardized electronic health records in the process of family doctor team service, and gradually realize the automatic collection, update and interconnection of the main health information of contracted residents. At the same time, all localities should actively integrate the existing medical and health resources in the region, connect comprehensive (specialist) medical institutions with primary medical and health institutions, and build remote services such as remote pathological diagnosis and remote medical imaging diagnosis (including images, ultrasound, electrocardiogram, etc.). ), remote monitoring, remote consultation, remote case discussion, and provide technical support for family doctors.
19. Pass? Internet plus medical care? Optimize the form of contract services. Encourage family doctors to sign up for service teams? Internet plus medical care? , through the establishment of WeChat group, QQ group, patient network and other channels, build a communication platform for both parties to the contract service. Actively use mobile internet, wearable devices, etc. Provide services such as online appointment for diagnosis and treatment, waiting reminder, price payment, diagnosis and treatment report inquiry, drug distribution and health information collection for contracted residents.
Third, the job requirements
20. Strengthen organizational leadership. All localities should, in light of the actual situation, incorporate the family doctor contract service into the content that governments at all levels are currently creating? Health promotion demonstration village? 、? Health promotion demonstration community? Establish an index system and incorporate it into the strategy of healthy city, healthy town, healthy village and healthy city. Timely introduction of specific plans to carry out the contract service system for family doctors. Effectively strengthen organizational leadership and overall coordination, form a working mechanism led by the government, coordinated by departments and participated by the whole society, and ensure that all tasks are put in place. Strengthen the connection between family doctor contract service and the comprehensive reform of public hospitals and the construction of graded diagnosis and treatment system, and form a superposition effect and a joint force of reform.
2 1. Strengthen division of labor and cooperation. Provincial Medical Reform Office, Provincial Health and Family Planning Commission, Development and Reform Commission, Department of Civil Affairs, Department of Finance, Department of Human Resources and Social Security, Bureau of Traditional Chinese Medicine, Disabled Persons' Federation and other units should establish a collaborative working mechanism and implement various tasks according to their respective responsibilities. The Provincial Health and Family Planning Commission is responsible for organizing and coordinating the contract service of family doctors, grasping the overall direction, taking the lead in formulating relevant policy documents, and guiding the coordinated development of urban and rural areas and regions. Do a good job in quality control and standardize the access, provision, assessment and supervision of contract services. The Provincial Development and Reform Commission is responsible for bringing the contracted service of family doctors into the development plan of health service industry, making overall consideration of the level of economic and social development and social affordability, gradually improving the medical price policy, setting the basic medical service price of public medical institutions, and guiding patients to be rationally diverted through price leverage. In promoting the combination of medical care and nursing care, the Provincial Civil Affairs Department has instructed local civil affairs departments to purchase family doctor contract services for the elderly who meet the government funding conditions. The Provincial Department of Finance should strengthen the support for the construction of grass-roots talent team focusing on general practitioners, constantly improve the compensation mechanism of grass-roots medical and health institutions, establish a mechanism linked to the quantity and quality of contracted services, and support the development of medical and health undertakings in economically underdeveloped areas through transfer payments. The Provincial Department of Human Resources and Social Security is responsible for guiding all localities to make overall plans for general outpatient services and deepen the reform of medical insurance payment methods. The Provincial Bureau of Traditional Chinese Medicine is responsible for strengthening the training of urban and rural family doctors in the application of appropriate technology of traditional Chinese medicine, organizing the formulation of appropriate technical service packages of traditional Chinese medicine for multi-level contracted residents, strengthening the comprehensive service area of traditional Chinese medicine in primary medical and health institutions and basic diagnosis and treatment equipment, and improving the service capacity of primary Chinese medicine. Provincial Disabled Persons' Federation is responsible for promoting local disabled persons' federations to purchase rehabilitation services provided by primary medical and health institutions for the disabled by purchasing services.