Regulation relating to a Municipal Regular GP Scheme

Published under: Stoltenberg's 1st Government

Publisher Sosial- og helsedepartementet

With Comments

With Comments

Regulation relating to a Municipal Regular GP Scheme

With comments

Laid down by the Ministry of Health and Social Affairs 14 April 2000 pursuant to Act No. 66 of 19 November 1982 relating to the Municipal Health Services section 1, subsection 3, seventh paragraph, section 1, subsection 3a, section 2, subsection 1a fourth paragraph and section 4, subsection 2 and Act No. 42 of 13 June 1980 relating to Medical Practitioners section 28.

CONTENTS

linkintHoveddelCHAPTER 1 OBJECT AND DEFINITIONSChapter 1 Object and definitions

  • § 1 - Object
  • § 2 - Definition

linkintHoveddelCHAPTER 2 PERSONS REGISTERED WITH A REGULAR GPChapter 2 Persons registered with a regular gp

  • § 3 - The Right to Register
  • § 4 - Registering Children
  • § 5 - The Right to Change Regular GP
  • § 6 - The Right to a Second Opinion

linkintHoveddelCHAPTER 3 THE REGULAR GENERAL PRACTITIONERSChapter 3 The regular general practitioners

  • § 7 -The Obligations of the Regular GPs to the Persons Registered with Them
  • § 8 -The Responsibility for Regular GP Registered Persons when in Institutions
  • § 9 -Regular GP Contracts in Group Practices
  • § 10 -Remuneration of a Self-Employed Regular GP

linkintHoveddelCHAPTER 4 ORGANISING THE REGULAR GP SCHEME IN THE MUNICIPALITIES Chapter 4 Organising the regular GP scheme in the municipalities

  • § 11 -The Responsibility for Organising the Regular GP Scheme
  • § 12-The Terms of Regular GP Contracts
  • § 13 -Entering into a New Regular GP Contract

linkintHoveddelCHAPTER 5 THE REGULAR GP LISTSChapter 5 The regular GP lists

  • § 14 -List Size
  • § 15 -Prioritising Applicants to Full Lists
  • § 16 -Reducing Lists

linkintHoveddelCHAPTER 6 SPECIAL MEASURES TO MEET A SHORTAGE OF DOCTORSChapter 6 Special measures to meet a shortage of doctors

  • § 17 -Suspension

linkintHoveddelCHAPTER 7 TRANSITIONAL PROVISIONS. COMING INTO FORCEChapter 7 Transitional provisions. coming into force

  • § 18 -The Responsibility of the Municipality to Provide a Regular GP upon Implementation of the Scheme
  • § 19 -The Right to a Regular GP Contract
  • § 20 -Special Provisions Regulating the Establishment of Regular GP Lists upon Implementation of the Scheme
  • § 21 -The Coming into Force of the Regulation Relating to a Municipal Regular GP Scheme

CHAPTER 1 OBJECT AND DEFINITIONS

§ 1 – Object

The object of the RGP Scheme is to improve the quality of the general medical services by ensuring that residents of Norway are granted the right to register with their own RGP. The RGP Scheme shall provide the population more security through better access to the general medical services.

§ 2 – Definition

Regular General Practitioner (RGP) : A doctor who has entered into contract with the local authorities to participate in the RGP Scheme.

CHAPTER 2 PERSONS REGISTERED WITH A REGULAR GP

§ 3 – The Right to Register

Any resident in a Norwegian municipality ( kommune) has the right to be registered with an RGP. "Resident" in this context means a person listed in the official registers as residing in that municipality. The term resident here also covers asylum seekers and their families who are members of the Norwegian National Insurance Scheme, cf. Regulation No. 315 of 15 April 1997 relating to the right to payment from the National Insurance Scheme for asylum seekers and members of their families.

A person who is entitled to be registered with an RGP, can request registration with an RGP of his/her choice. Their request should be granted provided there is free capacity on this doctor’s list except in those cases covered by the provisions in this Regulation.

A person who has no particular preference as to choice of RGP, will be assigned to a list with free capacity. A person who wishes not to be registered with any RGP, notifies the local authorities.

A person may choose to register with an RGP in another municipality than the one where he/she is a resident.

A person who moves will receive an RGP registration form with the option to register with an RGP in the new municipality.

§ 4 – Registering Children

The person or persons with custody choose an RGP for children under 16. If no choice is made the child is placed on the same list as the person or persons with custody of the child. Where the parents share custody and have the same address, the child will be placed on the same list as its mother. Where the parents share custody but have separate addresses, the child is placed on the same list as the parent officially registered at the same address as the child.

When the child turns 16 it can choose his/her own doctor. When the child is between 12 and 16 it can request to be registered with an RGP of his/her own choice with the approval of its guardian. When the parents have lost care and/or custody, as regulated by the Child Care Act section 4, subsection 8, section 4, subsection 12 and section 4, subsection 20, the Child Care Services may choose an RGP for this child.

§ 5 – The Right to Change Regular GP

A person who is registered with one RGP has the right to change RGP a maximum of twice a year, provided there is free capacity on the requested list. The RGP cannot refuse to accept the person if there is free capacity. The change is organised through the local National Insurance office.

When a child turns 16 he/she requests a change of doctor on his/her own behalf. When the child is between 12 and 16, it can request a change with the approval of its guardian/s. When the child is under 12, such a request is made by the child’s guardian/s.

§ 6 – The Right to a Second Opinion

A person registered with an RGP has the right to seek a medical examination by a doctor other than his RGP, provided this second doctor is also part of the RGP Scheme and the patient agrees to having his medical record sent to his/her own RGP.

CHAPTER 3 THE REGULAR GENERAL PRACTITIONERS

§ 7 – The Obligations of the Regular GPs to the Persons Registered with Them

The RGP has a duty to provide general medical services to the persons registered with him/her within the framework stipulated by law, regulation and collective agreement relating to the RGP Scheme. In his clinical practice the RGP shall give priority to the persons on his/her list, unless there are duties with a higher or equal priority imposed on the doctor by law or pursuant to law.

§ 8 – The Responsibility for Regular GP Registered Persons when in Institutions

If a person registered with an RGP is admitted to an institution of health or other institution with an organised medical service, the responsibility for the patient as stated in section 7 is transferred to the institution. Said person nevertheless remains registered with his/her own RGP, and the RGP is responsible for organising any adjustment to the patient’s proffered medical care upon their discharge. When such adjustment of medical care is needed, the institution in question shall inform the RGP beforehand. It shall furthermore provide the RGP with the patient’s case record on his/her discharge from the institution as stipulated in section 45 of the Medical Practitioner Act ( legeloven).

§ 9 – Regular GP Contracts in Group Practices

The RGP Scheme contract is signed with the individual practitioner, also when this RGP works in a group practice. Working in a group practice does not change the obligations of an RGP to the persons registered with him/her, unless a joint list has been established in accordance with the second subsection.

Within the framework stipulated by the collective agreement a group practice may agree to share a joint list. RGPs with persons registered on a joint list share the responsibility for the general medical services of the persons on that list. Persons on a joint list shall have one doctor with the main responsibility for their medical records and follow-up care. The regulations in section 12, subsection letter a, sections 14 and 16 relating to list size and reduced lists are valid also for joint lists.

§ 10 – Remuneration of a Self-Employed Regular GP

The remuneration of a self-employed RGP for the work paid according to the regular tariff consists of a capitation fee from the municipality and a consultation fee (at the going rate) and a fee-for-service reimbursement from the National Insurance Services.

Municipalities with a population of less than 5000 inhabitants shall pay a levelling grant to RGPs when the average list size in the municipality is less than the reference list agreed-upon. Said grant shall equal the difference between the capitation fee for the reference list and the capitation fee for the average list size in the municipality.

CHAPTER 4 ORGANISING THE REGULAR GP SCHEME IN THE MUNICIPALITIES

§ 11 – The Responsibility for Organising the Regular GP Scheme

It is the local authorities that shall organise the RGP Scheme, including entering into contract with a requisite number of doctors. Municipalities may work together on the organising of the RGP Scheme. In the RGP Scheme the norm shall be a self-employed RGP.

§ 12 – The Terms of Regular GP Contracts

The local authorities may demand the following terms met before entering into a contract:

a)That the RGP agrees to a fixed maximum list size. From 1 January 2001 this number is set at 1500 for a full-time practice. The maximum list size of a part-time practice will be adjusted proportionally.

b)That the RGP agrees to perform certain public general medical duties. Performing such duties entails the right to a proportional reduction in the list size established in subsection letter a.

c)That the RGP takes part in the organised out-of-hours services and in the organised emergency first aid services during normal practice hours, including availability on the medical radio network and answering emergency calls.

d)That the RGP takes part in supervising newly qualified doctors in their compulsory practice period.

The terms in the first subsection can be supplemented through collective bargaining.

Statutory participation in the out-of-hours work cf. subsection letter c is imposed in section 28, second subsection, of the Medical Practitioner Act and applies even in the case of a conflict.

§ 13 – Entering into a New Regular GP Contract

A new RGP contract may be entered into when an RGP ends his/her practice and his/her contract, when there is a vacancy filled, or when a municipality has been granted a new practice licence.

When a new RGP takes over the practice of an RGP leaving his/her practice and ending his/her contract, the latter’s list is transferred to the new RGP.

The persons on said list, will be informed by the local authorities of the change of doctor and of their right to change RGP as stated in section 5.

If the operation of a new RGP practice depends on it, the local authorities may transfer the following category of persons to the new list:

a)New applicants with no expressed preference for a particular RGP.

b)Persons registered on a list that has been reduced as provided for in section 16, and who have not transferred to another RGP with free capacity on his/her list.

CHAPTER 5 THE REGULAR GP LISTS

§ 14 – List Size

The normal size of an RGP list shall be a maximum number of 2500 and a minimum number of 500 persons registered. Individual agreements regarding list size may be entered into, within the framework stipulated in the collective agreements. A list size exceeding the 2500 maximum can only be agreed for a period of one year at a time.

§ 15 – Prioritising Applicants to Full Lists

When more than the maximum number of persons allowed are requesting to be registered on a particular RGP list, said list shall not exceed the agreed maximum list size. Those who are patients of this RGP will be given priority according to the length of the patient-doctor relationship. If this does not bring the list size down sufficiently, the National Insurance Services will make a random selection.

When establishing a list with a Sami-speaking RGP who practises in an administrative district where Sami is an official language, Sami-speaking persons shall have priority to be registered on that list.

§ 16 – Reducing Lists

When the list of an RGP exceeds the maximum size stipulated in this Regulation and in collective agreements, the RGP is entitled to have the number of persons on his/her list brought down to that maximum number. The local authorities shall be notified of this reduction claim and then be allowed six months in which to act.

The list is reduced through a random selection of those registered with the RGP in question.

CHAPTER 6 SPECIAL MEASURES TO MEET A SHORTAGE OF DOCTORS

§ 17 – Suspension

The County Medical Officer ( fylkeslegen) can upon application from the local authorities suspend the obligation to provide an RGP Scheme. Suspension can only be consented to when local solutions have been attempted and there is reason to believe the local authorities will be unable to fulfil said obligation for a period of at least 3 months.

The County Medical Officer shall oversee that the municipal plan for the general medical services ensures that the other obligations imposed by the Municipal Health Services Act section 1, subsection 3, second paragraph, part 1 are met during the period of suspension. Suspension can only be consented to for a maximum of 1 year at a time.

The local authorities or the local RGPs have the right to appeal to the Ministry against the decision of the County Medical Officer.

CHAPTER 7 TRANSITIONAL PROVISIONS. COMING INTO FORCE

§ 18 – The Responsibility of the Municipality to Provide a Regular GP upon Implementation of the Scheme

Upon implementation of the RGP Scheme it is the duty of the local authorities to ensure that all officially registered residents are given the option to register with an RGP. Also the categories of persons mentioned under section 3, first subsection, third period point.

§ 19 – The Right to a Regular GP Contract

Doctors who, when the RGP Scheme is being introduced, practise general medicine as employee or as self-employed, with or without a municipal contract, have the right as stated in section 12 to enter into an RGP contract in the municipality where his/her main practice is. A doctor on leave at the time of implementation has the same right to an RGP contract. Doctors who wish to exercise this right must notify the local authorities within the date set by the Ministry.

Local authorities that consider a medical practitioner not to meet the required conditions must make known this refusal within the date stipulated by the Ministry, otherwise the acceptance of said doctor’s claim is assumed.

A medical practitioner employed as GP in a municipality at the time the RGP Scheme is introduced, has the right to maintain his employment status pursuant to existing agreements and regulations that apply.

The decision to refuse an RGP contract can be appealed to the Ministry. This appeal is to be sent directly to the Ministry.

§ 20 – Special Provisions Regulating the Establishment of Regular GP Lists upon Implementation of the Scheme

RGPs who so wish may, upon the introduction of the RGP Scheme, request that their list be established according to the following criteria: 70% of the agreed maximum number is filled with persons who have requested this particular doctor, and the rest of the list, up to the number of persons who have requested to be registered with this RGP, with a selection among persons who have expressed no preference or have not had their request granted. When establishing said RGP list the selection shall aim at achieving a profile corresponding to the population average.

§ 21 – The Coming into Force of the Regulation relating to a Municipal Regular GP Scheme

The provisions under sections 1, 2, 9, 11, 12, 13, 14, 15, 17, 18, 19, 20 and 21 will come into force immediately.

The regulations of patients’ rights under sections 3, 4, 5 and 6, of the obligations and responsibilities of the RGP towards those registered with him/her under sections 7 and 8, of remuneration under section 10 and also provisions under section 16 relating to the reduction of list size come into force from the date stipulated by the Ministry.

VEDLEGG