The People's Governments of cities and counties in all districts, the Administrative Committees of the leading districts, the relevant departments of the Municipal Governments, and all relevant units:
To implement the spirit of “Views of the General Office of the State Council on the Reform and Perfection of the Incentive Mechanism for the Training and Use of General Practitioners” (Issued by General Office of the State Council  No. 3) and “Opinions of the General Office of the Liaoning Provincial People's Government on the Reform and Perfection of the Incentive Mechanism for the Training and Use of General Practitioners" (Issued by Liaoning Government General Office  No. 16), reform and improve the general practitioner training system and use of incentive mechanism, now put forward the following implementation suggestions through the consent of the Municipal Government.
I. Overall Requirement
1. Guiding ideology.
Guided by Xi Jinping's thought of socialism with Chinese characteristics in the new era and in accordance with the relevant strategic plans and work requirements put forward by the 19th National Congress of the Communist Party of China, we should conscientiously implement the policy of health and health work, and be guided by problems and needs to follow the law of the growth of medical and health service and clinical medical talents, insist on the government leading, give play to the role of market mechanism, draw lessons from the advanced experience at home and abroad based on the reality of Dalian, consolidate and perfect the training system of general practitioners adapted to the characteristics of the profession. Explore and innovate the incentive mechanism of general practitioners and provide reliable general medical talents support for achieving the goal of healthy Dalian construction.
2. Basic principle
-- Government-led and multi-party participation. Promote the supply-side reform of basic medical and health services, implement the government's leading responsibility in building the contingent of health personnel, give full play to the role of the market, and fully mobilize the enthusiasm and creativity of social forces such as medical and health institutions and medical colleges and universities, etc. Jointly establish and perfect the general practitioner system in our city.
--Demand oriented and scientific layout. In order to meet the needs of the people's basic medical and health services, the overall layout of general medicine development is planned as a whole and the general medical and health service system is established and perfected based on the actual needs of the establishment of hierarchical diagnosis and treatment system;, Promote the establishment of a medical and educational cooperative personnel training system which is effectively linked by college education, post-graduation education and continuing education and guided by the training needs of general practitioners.
--Optimize stock and lift increment. Pay equal attention to training and introducing, give full play to the advantages of existing policies, train qualified general practitioners through many channels, innovate general practitioners to introduce "green channels", vigorously introduce outstanding general practitioners with rich clinical experience, guide and encourage graduates of medical colleges to work in general practice in primary medical and health institutions, and continuously improve the total number of general practitioners in our city.
--Innovative mechanism and optimize environment. Strengthen the policy encouragement and support, perfect the general practitioner management system, standardize the classification diagnosis and treatment system and family doctor contract system characterized by the general practice medicine model, perfect the performance appraisal and incentive guarantee mechanism, establish a growing environment conducive to the professional development of general practitioners and continuously improve the scientific level of general practice personnel work.
3. Employment objective.
By 2020, we will gradually improve the general practitioner training system suitable for the actual situation in our city, basically improve the incentive mechanism to adapt to the development of general practitioners, significantly enhance job attractiveness and service capacity of general practitioners. A relatively stable service relationship between general practitioners and urban and rural residents has basically been established. There are more than three general practitioners per 10,000 people in the city, and qualified areas are encouraged to advance the goal of having five general practitioners per 10,000 residents. There are at least 2 or 3 general practitioners in each township health center and community health service center, and at least one general practitioner in each community health service station, which basically forms the service mode of "first visit at the basic level". By 2030, the training system of general practitioners adapted to the characteristics of the industry and the incentive mechanism are more perfect. Every 10,000 residents in urban and rural areas have at least 5 qualified general practitioners, which basically meets the construction needs of healthy Dalian.
II. Establish and perfect the training system of general practitioners adapted to the characteristics of the profession
4. Promote the reform of general medicine education in medical and educational cooperation colleges. Dalian medical colleges and universities should strengthen the construction of general medicine, develop general medicine education for all medical students, set up compulsory courses such as general practice medicine, etc. and integrate general medical knowledge and skills into the whole teaching process. Qualified medical institutions are encouraged to set up general-practice medical teaching and research departments, departments of general medicine or general practice schools. Based on the standardized training base and assistant general practitioner training base, a number of general practice teaching bases should be built. Strengthen the construction of general-medicine teachers, support in staffing, job title evaluation, workload assessment, etc. Medical colleges and universities are encouraged to employ general practitioners with teaching potential in general practice teaching base to undertake teaching tasks, and qualified teachers can be appointed to professional and technical posts. Continue to implement the rural order oriented medical students free of charge training program and to promote rural grass-roots local general practitioners training program. Speed up the formalization and systematization of the cultivation of general practitioners to serve the needs of the development of general practice, perfect the general medicine education system in our city and to promote the establishment and development of the general practice system.(Lead unit: Municipal Bureau of Education, Municipal Health and Family Planning Commission; Coordination unit: Municipal Bureau of Social Affairs, Dalian Medical University, Dalian University)
5. Establish and improve the system of general practice education after graduation. Vigorously promote the training of high-level general practitioners with the emphasis on standardized training of resident physicians, expand the scale of the standardized training of resident physicians in general practice and increase the number of general specialty students to 20% of the total enrollment plan of that year by 2020, and it will increase year by year. Complete the recruitment of general-practice major into the resident standardized training base assessment, and link it to the funds in accordance with the relevant regulations and financial subsidies. Carry out assistant general training, and all medical graduates who are trained free of charge in rural orders take part in assistant general practitioners training. For the personnel appointed by the unit to participate in the standardized training of resident doctors and the training of assistant general practitioners, the appointing unit shall sign an agreement with them on the treatment during the training period, the length of service after the expiration of the training period, and the measures to deal with the breach of contract.
Promote the construction of general practice departments in urban tertiary general hospitals and county-level public hospitals, establish independent general practice departments, township health centers, and community health service institutions in general hospitals that are recognized as standardized training bases for resident doctors and form an effective general practice medical service system. General practice medical staff should have general practice qualification, including transfer training or teacher training to obtain a certificate of general practitioners and general practice teachers and so on. In the internal distribution, it is necessary to reasonably determine the performance wage level of medical personnel in general medicine, appropriately increase the inclination and attract and stabilize outstanding professionals.
We should do a good job in the construction of the teaching staff of general practice medicine, train the backbone teachers, and undertake the teaching guidance task in the general hospital training base and the basic practice base. Improve the teaching consciousness and ability of teachers, and the teaching achievement should be included in the performance appraisal. Also the teaching experience and teaching quality should be taken as the important factors for the promotion of professional titles. (Lead unit: Municipal Health and Family Planning Commission; Coordination unit: Municipal Bureau of Finance, Municipal Bureau of Social Affairs)
6. Consolidate and perfect general continuing medical education. Improve the system of continuing education for general practitioners and guarantee their right to participate in continuing education and their treatment during their studies. In accordance with the national guidelines for continuing education in general practice, we should give full play to the role of higher medical colleges, large urban hospitals, county-level general hospitals, and social academic organizations, strengthen the construction of educational and training bases, focus on new knowledge and skills, new theory and new method, carry out the general medicine education and training activity, popularize the general practice suitable technology, and improve the general practitioner's theory and practice skill level continuously. (Lead unit: Municipal Health and Family Planning Commission; Coordination unit: District and County Government, Pilot District Administration Committee, Municipal Bureau of Social Affairs, Municipal Bureau of Finance)
III. Improving the professional attractiveness of general practitioners in an all-round way
(7) Reform and improvement of the GP pay system. To promote the reform of medical service price, the general practitioner as a breakthrough, reflect the value of medical staff technical labor. In accordance with the "allow medical and health institutions to break through the current level of wage control in public institutions, allow medical services income to deduct costs and withdraw funds in accordance with the provisions of the main use of personnel incentives" requirements, reasonable approval of the Government to run primary health care institutions, the total performance wage, improve the level of general medical and health institutions general practitioners The salary level of the clinician is connected with the salary level of the clinicians on the same condition as the local county General Hospital. To encourage primary health care institutions to employ general practitioners who have standardized training for residents, to give them a further tilt in the total amount of approved performance wages, and to effectively increase the attractiveness of GP posts. Establish the normal growth mechanism of performance wage level in primary medical and health institutions. We should improve the distribution of performance wages, arouse the enthusiasm of medical staff in primary medical and health institutions, and encourage all units to establish general practitioner's allowance in the internal performance wage distribution.
Conscientiously implement the notice on issuing the implementation opinion of Dalian to promote the signing service of family doctors (David ﹝2017﹞144), vigorously promote the work of family doctors signing services, and gradually form a signing service team with general practitioners as the main body. According to the provincial family doctor signing service guidance norms, further enhance the family doctor signing service connotation. The signing service fee is shared by the Medicare fund, the basic Public health service funds and the contracted residents ' paid three parties, as the income component of the primary medical and health institution where the family Doctor team is located, according to the completion of the work in accordance with the 50%-70% ratio for the distribution of personnel pay, and does not include the total performance wage control base, and will 10% The proportion of the family doctor's team professional ability to improve the education and training activities. Carry out the performance evaluation of family doctor signing service, comprehensively reflect the quantity, quality and effect of family doctor signing service, and ensure the quality of contracted service. The general clinics organised by the social forces are encouraged to provide family doctor signing services, and by the end of 2018 there were no fewer than 5 general clinics in our city to provide family doctor signing services. (Lead unit: District and city government, pilot District Management Committee; Cooperation unit: Municipal Development and Reform Commission, Municipal Health Family Planning committee, Municipal Department of Human Resources and Social Security, Municipal Finance Bureau)
(8) To improve the management of the employment of general practitioners. The government to run the primary health care institutions in the approved establishment to ensure the staffing of general practitioners, priority to the undergraduate and above medical graduates or standardized training of qualified general practitioners, simplify the recruitment process, can take interviews, organizational visits and other means of open recruitment. The general practitioner who is qualified to practice in the rural grassroots through the standardized training of residents may implement "County Management township" (employed by county medical and health institutions, used in township hospitals, and enjoy the performance distribution of contracted service fees in accordance with the relevant provisions). For college graduates who work in township hospitals and recruit as regular staff, they can be graded in advance, and the salary level salary at the time of grading is higer level. (Lead unit: District and city government, pilot District Management Committee; Cooperation unit: Municipal Health and Family Planning Board, Municipal Department of Human Resources and social Security, Municipal editorial office)
(9) To expand the career development prospects of general practitioners. In the construction of clinical physician team, primary medical and health institutions should treat the undergraduate students with standardized training qualified by residents, in the aspects of personnel recruitment, job title promotion, job employment and so on, with clinical medicine, Master's degree in traditional Chinese medicine, etc., and implement wages and other related treatment.
Increase the proportion of middle and senior professional and technical posts in primary health care institutions, focusing on the standardized training of general professional residents and the standardized training of professional specialists’ qualified GP tilt. Bachelor degree or above, graduated from general professional resident standardized training qualified and working in the primary medical and health institutions, can directly participate in the intermediate title examination, examination pass, directly appointment of intermediate positions. When the basic general practitioner takes the intermediate title examination or declares the senior title, the foreign language achievement does not act as the declaration condition, does not make the hard rule to the thesis and the scientific research, focuses on the evaluation clinical work ability, the resident contract quantity, the reception quantity, the service quality, the mass satisfaction and so on as the title appraisal important basis and separate review. General practitioners who have been recruited through special post plans may take the intermediate health Professional technical Qualification Examination one year in advance and obtain the corresponding qualifications, which may be appointed on a priority basis under the same conditions. The working hours of GPs who is general practitioners ' special job plans in township hospitals, are calculated as the time for urban doctors to serve at the grassroots level before they are promoted to Deputy Chief physician.
GPs are included in the range of health personnel training that the Government has focused on supporting. For students assigned to General Medical resident, assistant general practitioner and other standardized training, the implementation of tilt subsidy policy, for the inclusion of Liaoning Province order targeted medical students free training program students, according to the standard to provide training fees. The implementation of discipline construction, scientific research, academic platform and key personnel training priority plan, all levels of medical and health institutions at all levels to declare the municipal general medical key disciplines, can relax the conditions, give priority support, carry out general medical science related research, priority into the city Science and Technology Innovation Fund Guide, declare the medical and health industry scientific Research Plan, Not limited by the amount of declaration; Play the role of social organization, support the establishment of general medical specialty branches or professional committees, build academic exchange platform, enhance the academic status of general practitioners, and establish a long-term mechanism for the academic development of general medicine. (Lead unit: Municipal Department of Human Resources and social Security, Municipal Health and Family Planning Board; Cooperation units: Municipal Finance Bureau, Municipal Science and Technology Bureau)
(10) Encourage social forces to organize general clinics. To implement the national policy measures to promote the accelerated development of social doctors, the relevant planning layout of medical institutions does not restrict the setting of general clinics and implement market regulation. All regions should further standardize the examination and approval behavior, fully clean up and eliminate unreasonable pre-approval matters, integrate the establishment of general clinics, practice permits and other approval links, further clarify and shorten the time limit for approval, and announce to the community the approval process, the subject of approval and the time limit for the approval of general clinics. Support eligible GP individuals or partnerships to open general clinics in urban and rural areas to provide health care services to the nearest population. The Tertiary general Hospital is encouraged to establish a two-way referral mechanism with the GP in the jurisdiction to open the referral channels. We should strengthen government supervision, industry self-discipline and social supervision, make full use of new media and other means to supervise and guide general clinics to practice according to law, enhance their legal awareness, and promote the standardized development of general clinics. We will include general clinics organized by social forces in the scope of industry-wide supervision of medical institutions, strengthen post-mortem supervision, promote the "double random, one public" working mechanism, investigate and punish illegal practice in accordance with the law, and disclose the results of spot checks and information on administrative penalty cases to the community.
For non-profit general-class clinics that provide basic health services, implement the same subsidy policy as the government's primary health care institutions in terms of personnel training, and the Government, through the purchase of services, directs it to participate in the provision of local basic medical and basic public health services and to undertake relevant tasks issued by the Government, and gradually expand the scope of purchase; For eligible, in accordance with the provisions of the scope of medical insurance, to provide family doctor signing services, priority to be included; for the conditions, can be identified as a general practitioner grass-roots practice base, to undertake the task of general practitioners training. For development and construction expenses such as the acquisition of infrastructure and equipment in general clinics, areas in a position to do so may be given appropriate support through financial subsidies, etc. (Lead unit: Governments in all districts, municipalities and counties, Pilot District Management committee, Municipal Health and Family Planning Board; Cooperation Unit: Municipal Finance Bureau, Municipal Department of Human Resources and social Security)
(11) Enhance the sense of honor of professional pride of general practitioners. Adhere to the combination of spiritual rewards and material rewards, the introduction of government incentive-oriented, unit incentives as the main body, social incentives as a supplement to the GP incentive method, to enhance the sense of professional pride and social status of general practitioners. General practitioners who have long been rooted in the grassroots and make outstanding contributions are rewarded in accordance with the relevant provisions. In the enjoyment of special government allowance personnel selection and outstanding professional and technical personnel, advanced workers (model workers), May day (Labor) medals, outstanding Communist Party members and other recommendations and selection work, pay attention to the selection of personnel with GP experience. All regions are encouraged to carry out GP incentive work in accordance with the relevant regulations. (Lead unit: Municipal Health and Family Planning committee, district and City governments, pilot District management committees; cooperation units: Municipal Department of Human Resources and social Security, City Federation of Trade Unions)
IV. Speeding up the resolution of the serious shortage of general practitioners at this stage.
(12) In-depth transfer training of general practitioners. Actively encourage relevant specialists in hospitals level two and above to participate in the transfer training of general practitioners, to increase the scope of general medical professional practice on the basis of the original registered practice scope, and to provide general medical services for those who are qualified after the training. Before 2030，all eligible clinicians and village doctors with practicing (assistant) physicians in primary health care institutions are included in the transfer training of general practitioners. (Lead unit: Municipal Health and Family Planning Organization; Cooperation Unit: Municipal Finance Bureau)
(13) Strengthen the introduction of general medical talents. Encourage and support all types of medical and health institutions at all levels to introduce full-time provincial and municipal high-level general medical personnel to even innovative entrepreneurship, eligible to enjoy the cost of installation, children's schooling, health care, accompanying spouse employment and other treatment. The general medical talents are included in the catalogue of shortage of talents in key industries in Dalian City, and the shortage of general medical talents found to be introduced full-time can enjoy the policies of rental subsidy or purchase subsidy, children's schooling, accompanying spouse employment and so on, and the government salary subsidy can be enjoyed after selection with advanced professional and technical qualifications or master's degree or above. Actively guide Medical college graduates to work at the grass-roots level, in line with the conditions, can enjoy our city to support talent innovation and entrepreneurship related policies. (Lead unit: Municipal Health and Family Planning Board, municipal Municipal Department of Human Resources and social Security, district and city government, pilot District Management Committee; Cooperation units: Municipal Finance Bureau, Municipal Education Bureau, Municipal Land and housing Bureau, etc.)
(14) Strengthening the training of rural doctors in general medical knowledge. To implement the job training plan for village doctors, with emphasis on improving the basic theoretical level of common diseases and morbidity at the grass-roots level and to enhance the practical operation ability of general medicine, to carry out systematic training on the combination of theory and practice of village doctors in the city not less than 100 hours every 2 years, and to formulate a refresher training programed for village doctors, with practice (assistant) Physician qualified Village doctors in batches to township hospitals, county hospitals and other higher medical institutions for further study, to achieve the basic goal of competent GP post work. (Responsible unit: Municipal Health and Family Planning committee, district and city government, Pilot Area Management Committee)
V. Strengthening the construction of GP teams in hardship areas.
(15) Accelerate the expansion of the ranks of general practitioners in hard-to-rural areas. Continue to implement rural order targeted medical student free training. The national, provincial and municipal continuing medical education and training projects are implemented free of charge for economically weak and low-income areas through a combination of distance education and on-site centralized face-to-face. Further increase the level of medical and health institutions at or above the county level to support rural primary medical and health institutions, with the help of remote consultation and other means to improve the standard of basic GP services, solve the majority of rural residents’ treatment problems nearby. (Lead unit: Municipal Health and Family Planning committee, district and city government, Pilot Area Management Committee; Cooperation Unit: Municipal Education Bureau)
(16) To increase the recruitment of general practitioners for special posts. Continue to expand the scale of recruitment, for the public recruitment of a group of "establishment positions in the county hospitals or government-run township hospitals, personnel work in township health centers," the special post of general practitioners, to promote the large hospital health and technical personnel to the rural township reasonable diversion. During the 5 years term of office, general practitioners of special posts shall implement a unified national wage system and standards, and enjoy the wages and protection of similar personnel in the medical institutions in which the posts are compiled. The funds required for the implementation of the general practitioner special post plan shall be borne jointly by the city, County (city, district) finance. Special post GP daily management, performance appraisal (normal assessment) and annual assessment by the Township Health Care department, the examination results report the establishment of the post of medical institutions to record, outstanding achievements, assessment of outstanding, in the performance of the distribution of wages to be taken into account. (Lead unit: Municipal Health and Family Planning Committee; Cooperation unit: District and city government, Pilot Area Management Committee, municipal Department of Human Resources and social Security, Municipal Finance Bureau, Municipal editorial Board office)
(17) Promotion Policy for Job Title Further Inclines to Difficult Rural Areas.
General practitioners who have long been rooted in low-income villages and remote island primary medical and health institutions can break through the restrictions of academic qualifications and promote the title. General professional resident Standardized training qualified, access to intermediate titles in low-income villages and remote island primary medical and health institutions after 10 years of continuous work, can be judged by the title Evaluation Committee, directly obtained the deputy Senior title, the acquisition of Deputy senior titles in principle should be limited to the primary medical and health institutions to be appointed, When the primary medical and health institutions move to the higher medical and health institutions, they should obtain the unified senior titles of the province or the city. (Lead unit: Municipal Health and family Planning Society; Cooperation unit: Department of Human Resources and social Security)
(18)Encourage clinicians in large hospitals to practice more in grass-roots, remote and medical resource-scarce areas. To strengthen the construction of medical conjoined and the system of signing up for family doctors, medical institutions above the second level should actively encourage and co-ordinate arrangements to send registered general practitioners to primary medical institutions on an annual basis, to carry out family doctor signing services, and to enjoy the relevant policy treatment of family doctors signing contracts. The salaries of general practitioners who are sent to primary health care institutions shall not be paid less than the level at the time of their work in the unit. To implement the policy of regular service subsidy for urban health technicians to primary medical institutions, and to promote the rapid development of the capacity of clinical doctors in urban large hospitals to sink urban and rural grassroots, through mentoring, to promote the ability of basic general-care services. (Lead unit: Municipal Health and Family Planning Committee; Cooperation unit: Municipal Finance Bureau, District and city government, Pilot Area Management Committee)
VI. Improving safeguard measures
(19) Strengthen organizational leadership. All regions and departments should fully understand the importance of reforming and perfecting the incentive mechanism for the training and use of general practitioners as a key link and major task to deepen the reform of medical and health system, build a healthy Dalian, strengthen organizational leadership, strengthen departmental coordination, and ensure that reform initiatives are put in place. Each region shall, in accordance with the staffing and needs of general practitioners in the jurisdiction, formulate training and recruitment plans, make full use of the order orientation, special post plans and other policies, and complete the work objectives on schedule. (Lead unit: Municipal Health and Family Planning Commission, District and city government, pilot District Management Committee; Cooperation unit: Municipal Development and Reform Committee, Municipal People's Bureau, Municipal Finance Bureau, Municipal editorial Office, Municipal Education Bureau, City General Union, municipal Council of Agriculture)
(20) Deepening the reform of Medicare payment mode. Relying on primary medical and health institutions to promote out-patient co-ordination and pay-per-person fees, exploring the possibility of paying out-patient funds to primary medical and health institutions or family doctor teams according to the headcount fund of the contracted residents, For patients who are referred from the grass-roots level to the hospital, a referral fee is paid by the primary health care institution or by a team of family doctors. Summarize and popularize the mature experience, the vertical cooperation of the Medical Consortium and other division of labor collaboration model can be implemented to pay the total amount of health insurance, and strengthen the assessment, reasonable guidance of two-way referral, give full play to the GP and family doctor team in the medical insurance charge of the "gatekeeper" role, to promote health services from the treatment as the center to the (Lead unit: Municipal Health and family Planning Society; Cooperation unit: Department of Human Resources and social Security)
(21) Strengthen the guarantee of funds. Governments at all levels should implement the responsibility of investment, through government investment, units and bases self-financing, social support and other multi-channel financing, and further increase the support for the training and use of general practitioners, subsidies, funds earmarked, not to intercept, misappropriate, crowding out. (Responsible unit: Municipal Finance Bureau, Municipal Health and Family Planning committee, district and city government, Pilot Area Management Committee)
(22) Strengthening oversight, evaluation and accountability. The Municipal Health and Family Planning Commission shall, in conjunction with relevant departments, strengthen the supervision and supervision of policy implementation and the third-party evaluation, conscientiously summarize experience and promote good practices. All regions should incorporate the implementation of policies and measures, such as training and use incentives for general practitioners, into the examination of the objectives and responsibilities of medical reform, establish a mechanism of regular investigation and supervision, and promptly study and solve the problems and difficulties arising in the implementation. For areas where the implementation of the policy is weak and the target is not met, the reasons should be analyzed, and the relevant departments and personnel should be held accountable and informed in accordance with the relevant provisions. (Lead unit: Municipal Health and family Planning Society; Cooperation unit: Department of Human Resources and social Security, Municipal Finance Bureau, Municipal Education Bureau)
(23) Strengthen publicity and guidance. To publicize the significance and policy measures of the training and use of general practitioners through various forms of publicity, to widely publicize the typical cases of GP growth and the important role played in basic medical and health services, and to enhance the understanding of general practitioners among medical students, medical personnel, medical educators and the public, To speed up the training of a large number of qualified general practitioners to create a good public opinion environment. (Responsible unit: Municipal Health and Family Planning committee, district and city government, Pilot Area Management Committee)
Dalian Municipal People's government office
November 15, 2018