A circular on guidelines to promote family doctor contracting services

4. Who will provide family doctor contract service? What form of service will it take?

The family doctor is the first person responsible for providing contracted services to the masses. At present, family doctors are mainly undertaken by the following personnel: first, registered general practitioners in primary medical and health institutions (including assistant general practitioners and general practitioners of traditional Chinese medicine), second, competent doctors in township health centers and rural doctors, third, eligible public hospital doctors and retired clinicians with intermediate or above titles, especially internal medicine, gynecology, pediatrics, and traditional Chinese medicine doctors. At the same time, eligible non-governmental health care institutions (including individual clinics) are encouraged to provide contracted services and enjoy the same collection and payment policy. In the future, with the development of the talent team of general practitioners, a contracted service team with general practitioners as the core will be gradually formed.

In principle, the contracted service of family doctors should take the form of team service, mainly composed of family doctors, community nurses, public health doctors (including assistant public health doctors), etc., and there are doctors at or above secondary hospitals (including TCM doctors) to provide technical support and business guidance. In order to better meet the needs of the people for traditional Chinese medicine services, it will gradually realize that every family doctor team has a doctor or rural doctor who can provide traditional Chinese medicine services. Qualified areas can also absorb pharmacists, health managers, psychological counselors, social (justice) workers, etc., to join the team. Among them, the family doctor will be responsible for the task allocation and management of the team members, and other specialists and health technicians will also work closely with the team to provide quality services for the contracted residents.

5. How can residents sign up with a family doctor team?

Residents or families can voluntarily choose a team of family doctors to sign a service agreement. The service agreement will specify the content, method and duration of the contracted service, and the responsibilities, rights, obligations and other related matters of both parties. The service period of each contract is one year in principle, after which residents can choose to renew the contract according to the service situation, or choose another family doctor team to sign. Encourage and guide residents to sign contracts nearby, but also across regions to establish an orderly competition mechanism.

At the same time, it is also necessary to strengthen the connection between hospitals and grass-roots medical and health institutions. When guiding residents or families to sign contracts with family doctors, residents or families can also voluntarily choose a secondary hospital and a tertiary hospital, and establish a "1+1+1" combination contract service model, in which they can choose medical institutions according to their needs, and gradually transition to the grass-roots first diagnosis. Treatment outside the combination should be referred by the family doctor to form an orderly medical treatment pattern.

6. What services and benefits can residents get after signing the contract?

After signing up, residents will enjoy basic medical care, public health and agreed health management services provided by a team of family doctors. Basic medical services cover the diagnosis and treatment of common and frequently-occurring diseases, rational drug use, medical path guidance and referral appointment. The public health service covers the basic public health service items and other public health services stipulated by the state. Health management services are mainly based on the health status and needs of residents, to develop different types of personalized contract service content, which can include health assessment, rehabilitation guidance, home beds, home nursing, traditional Chinese medicine "treatment" service, remote health monitoring, etc. By continuously optimizing the content of contracted services to meet the diversified needs of residents for medical and health services.

The signing service will implement differentiated policies for the signed residents in terms of medical treatment, referral, medication, medical insurance, etc., to enhance the attraction of the signing service and the effective use of the signed service by residents. First, in terms of medical treatment, the family doctor team will take the initiative to improve the service model, and provide various forms of services such as whole-process service, on-site service, staggered service, and appointment service for contracted residents in accordance with the agreement. Second, in terms of referral, the family doctor team will have a certain proportion of hospital expert numbers, appointment registration, reserved beds and other resources, so as to facilitate the priority treatment and hospitalization of contracted residents. The general practice departments or designated departments of secondary and above hospitals will connect with the referral services of family doctors and establish a green referral channel for referred patients. Third, in terms of drug use, for contracted chronic disease patients, family doctors can extend a single dose of medicine at their discretion to reduce the frequency of patients' round-trip prescription. For the next transfer of patients, drugs can be prescribed according to the condition and the medical advice of superior medical institutions. Fourth, in terms of medical insurance, differentiated medical insurance payment policies will be implemented for the contracted residents, such as the continuous calculation of the starting line for the referred hospitalized patients who meet the regulations, and the contracted residents will receive a higher proportion of medical insurance reimbursement at the grassroots level, thus enhancing the willingness of residents to use the contracted services.