Health: What does Lauterbach’s family doctor offensive bring?

Better conditions for GP practices are intended to provide greater security for local care for millions of people across Germany. This is the aim of legislative plans by Federal Health Minister Karl Lauterbach, which the cabinet has initiated.

“This makes it easier for patients to get doctor’s appointments, unnecessary visits to the doctor are eliminated, and long waiting times in the doctor’s office are avoided,” said the SPD politician. Financial incentives are planned for this. Doctors’ representatives called for further steps, patient advocates and health insurance companies expressed doubts about improvements.

Lauterbach made it clear that the issue even has significance for democracy. We must not allow “medical banlieues” to develop in rural areas or in poorer parts of large cities – that is, hotspots where there is no longer sufficient care. There are already 5,000 GP positions vacant nationwide. The profession should therefore be made “more lucrative, less bureaucratic and therefore more attractive”. “I think that will work,” said the minister. Another incentive is that GPs can work more from home, for example to issue prescriptions or sick notes digitally.

Ageing society also affects family doctors

The offensive for better conditions is intended to maintain the practice network with a view to imminent waves of retirement. Family doctors are the first point of contact for insured people and guides in the system, according to the draft. There has been no further decline recently. According to the Federal Medical Register, there were 51,389 general practitioners at the end of 2023, 75 more than at the end of 2022. However, ten years earlier there were 52,262. Among general practitioners, the proportion of people over 60 is particularly high at 37 percent.

compensation

For general practitioners – as with pediatricians – usual upper limits on remuneration should be lifted. This means that you will definitely be rewarded for extra work, even if the budget has been exhausted. “Every service is paid for,” said Lauterbach. This should also make it more attractive for general practitioners to accept more patients again. The ministry estimates that the change will result in additional costs for statutory health insurance companies in the “low three-digit million range”.

New packages

Practices are to receive an annual “care allowance” for patients with mild chronic illnesses and little need for care. This is intended to avoid visits to the practice every quarter just to pick up prescriptions and create more free time. General practitioners can medically determine whether someone should come twice or eight times a year, Lauterbach explained. Practices that meet certain criteria – for example for home and nursing home visits or evening consultations after 7 p.m. – are to receive a new “reserve allowance”.

teenagers

According to the draft, psychotherapeutic services for children and young people are also to be improved. To this end, a new group of doctors is to be formed to plan for demand. This will enable “more precise control of the options for setting up” practices.

transparency

A digital information and comparison service is to be created for those with statutory health and nursing care insurance, as the draft states. Figures on approvals, rejections and objections to certain health insurance benefits should be available there – but also on processing times and the quality of advice and support offers.

MVZ

It should become easier for municipalities to set up medical care centers (MVZ) in which doctors work under one roof – among other things, by easing the amount of security deposits required.

In the waiting line

In order to get the project going, Lauterbach has identified some points that were controversial within the coalition. However, they should be called upon again in parliamentary deliberations. These include “health kiosks”, i.e. easily accessible advice centers for treatment and prevention in areas with many socially disadvantaged people. Lauterbach also wants to campaign for an end to homeopathic services at health insurance costs. The draft is now going to the Bundestag, and the first reading is scheduled for before the summer break.

Reactions

The General Practitioners Association welcomed “noticeable improvements” through the elimination of fee limits. But this is not enough to turn things around. The umbrella association of statutory health insurance companies complained about “little added value for a lot of premium money”. Without the control instrument of remuneration caps, there could even be fewer incentives to run practices in rural areas. The German Foundation for Patient Protection explained that a decision to do so depends on other factors. And for chronically ill, old people and people in need of care, it is becoming increasingly difficult to find a new family doctor after giving up a practice. Union expert Tino Sorge (CDU) complained that it was completely unclear how specialists should be supported.