For patients, family doctors are important nearby contact points and guides through the system every day. But the health network is strained in many places. Now the Lauterbach cabinet is launching the family doctor reform. What should change for patients.
Better conditions for general practitioners’ practices should ensure more secure on-site care for millions of people across Germany. This is the aim of Federal Health Minister Karl Lauterbach’s legislative plans, which the cabinet launched on Wednesday. “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 vacant GP positions 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.
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.
Remuneration: For general practitioners – as with pediatricians – usual upper limits on remuneration should be lifted. This means that you will certainly 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 “lower three-digit million range”.
New flat rates: Practices should receive an annual “care flat rate” for patients with mild chronic illnesses and little need for care. This should avoid visits to the practice every quarter just to pick up prescriptions and create more free time. Family doctors could medically determine whether someone should come twice or eight times a year, Lauterbach explained. Practices that meet certain criteria should receive a new “reserve flat rate” – for example for home and nursing home visits or evening consultations after 7 p.m.
Young people: 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 needs. This will enable “more precise control of the options for setting up practices” for the relevant practices.
Transparency: A digital information and comparison service is to be created for those with statutory health and nursing care insurance, as stated in the draft. Numbers 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 be easier for municipalities to set up medical care centers (MVZ) in which doctors work under one roof – among other things with relief in the amount of necessary security deposits.
On hold: In order to get the project going, Lauterbach has identified some controversial points 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 those 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.