Suggestions on further strengthening the construction of rural doctors
People's governments of cities and counties, departments and institutions directly under the provincial government:
In order to implement the spirit of the Implementation Opinions of the General Office of the State Council on Further Strengthening the Construction of Rural Doctors (Guo Ban Fa [20 15] 13) and the Notice of the People's Government of Anhui Province on Printing and Distributing the Pilot Program for Deepening the Comprehensive Reform of the Medical and Health System in Anhui Province (16), the construction of rural doctors was further strengthened.
I. Overall Requirements and Main Objectives
(1) General requirements. In accordance with the overall arrangement of deepening the comprehensive reform of the medical and health system, we should adhere to the mechanism of ensuring the basics, strengthening the grassroots and building, reform the service mode and incentive and restraint mechanism of rural doctors, improve and perfect the salary, pension and training policies of rural doctors, stabilize the rural doctors, improve the overall quality of rural doctors, strengthen the supervision of medical and health services, and comprehensively improve the level of village-level medical and health services.
(2) Main objectives. By 2025, we will ensure that rural doctors in the province generally have medical and health secondary school education or above, more than 50% of rural doctors have the qualification of practicing assistant doctors or above, the age, education and qualification structure of rural doctors will be more reasonable, the practice environment will be further optimized, and reasonable treatment will be effectively guaranteed. We will basically build a team of high-quality rural doctors to meet the needs of rural grassroots units, promote the establishment of the first diagnosis and graded diagnosis and treatment system at the grassroots level, and better ensure that rural residents enjoy equality and basic equality.
Second, improve the management system of rural doctors.
(3) Defining the responsibilities and tasks of rural doctors. Rural doctors (including practicing doctors and assistant doctors in village clinics, the same below) are mainly responsible for providing public health and basic medical services for rural residents, and undertaking other medical and health services entrusted by the health and family planning departments.
(D) Rational allocation of rural doctors' human resources. All localities should comprehensively consider the service population, service status, expected demand and regional conditions and rationally allocate rural doctors. In principle, rural doctors are equipped according to the standard of 1 per thousand serving population, and each village clinic has at least 1 rural doctors practicing. If there is no village doctor in the village clinic, the primary medical and health institutions shall send doctors to provide services, or introduce people with the qualification of practicing (assistant) doctors to work in the village clinic. Village clinic personnel exceed the prescribed standards, in principle, no new personnel.
(5) Strict access to rural doctors. County-level health and family planning departments should strictly examine the qualifications of rural doctors and strengthen access management in accordance with the Law of People's Republic of China (PRC) on Medical Practitioners and the Regulations on the Administration of Rural Doctors. Medical staff practicing in village clinics must have corresponding qualifications and be registered according to regulations. New personnel who enter the village clinic to engage in prevention, health care and medical services must obtain the qualification of practicing doctor or practicing assistant doctor; Personnel engaged in nursing, pharmacy and medical technology must obtain corresponding professional qualifications.
(six) standardize the assessment of rural doctors. County-level health and family planning departments should improve the performance evaluation methods for village clinics and rural doctors in accordance with the principle of paying equal attention to basic public health and basic medical care, and organize and implement the evaluation in a unified manner. The assessment contents include the quantity, quality and mass satisfaction of basic medical and public health services provided by rural doctors, the implementation of the basic drug system, compliance with the provisions of basic medical insurance, learning and training, and medical ethics. The assessment results serve as the main basis for the registration and funding of rural doctors. The specific assessment work is mainly undertaken by township hospitals, in principle, not less than 1 time per year. Establish an assessment and income distribution mechanism within the village clinic, and the income distribution is inclined to the backbone of the business.
(7) Strengthen the supervision of professional services. County health and family planning departments should strengthen the practice management and service quality supervision of rural doctors, promote rational drug use, and improve the safety and effectiveness of medical and health services. Gradually bring rural doctors into the medical staff practice supervision information system. Promote the integrated management of counties and villages, and promote township hospitals to lead village clinics. Severely crack down on rural doctors' illegal practice of medicine, illegal purchase and sale of drugs, induced services and overtreatment, and illegal referral of patients.
(8) Improve the withdrawal system of rural doctors. Establish and improve the mechanism for rural doctors to withdraw from exams, age and violation of laws and regulations. The assessment results of village clinics and rural doctors, as an important basis for the practice registration of rural doctors, shall not continue to practice in village clinics. Rural doctors who have committed serious crimes or serious medical ethics problems shall be revoked or temporarily detained, and ordered to withdraw from the village clinic. The governments of counties (cities, districts) have formulated methods for rural doctors to quit when they reach the age, and actively explored the mechanism for the withdrawal of surplus personnel from village clinics.
Third, strengthen the training of rural doctors.
(9) Strengthen academic education. Health and family planning departments at all levels should formulate training plans for rural doctors in accordance with the requirements of the National Education Plan for Rural Doctors (20 1 1-2020). Encourage qualified in-service rural doctors to enter higher medical (health) colleges (including Chinese medicine colleges) to receive medical education and improve the overall academic level. The government can give appropriate subsidies to the on-the-job rural doctors who have participated in academic education and obtained the corresponding doctor qualifications according to regulations.
(ten) the implementation of order oriented training. Strengthen the free training of rural order-oriented medical students, focusing on the free training of three-year university medical students facing village clinics. Free medical students mainly recruit rural students. Free medical students who have completed the standardized training of general practitioners can be arranged to work in the village clinic, and the working hours of the village clinic are included in the service period agreed in the agreement. County-level health and family planning departments and township hospitals with posts are inclined in terms of further training and professional title evaluation.
(eleven) standardize on-the-job training. All localities should rely on county-level medical and health institutions or conditional central township hospitals to carry out on-the-job training for rural doctors. Rural doctors receive free training not less than 2 times a year, and the cumulative training time is not less than 2 weeks. Encourage all localities to use information technology to carry out online training for rural doctors. All localities can send outstanding rural doctors with the qualifications of practicing doctors or practicing assistant doctors to provincial and municipal hospitals for free training. Rural doctors go to county-level medical and health institutions or conditional central township hospitals for full-time study every 3-5 years, and the study time is not less than 1 month in principle. Rural doctors should learn Chinese medicine knowledge and use Chinese medicine skills to prevent and treat diseases.
(twelve) to strengthen the construction of rural doctors reserve force. Establish a reserve bank of rural doctors. All localities should formulate preferential policies to attract urban retired doctors, practicing (assistant) doctors and medical (health) college graduates who have obtained professional qualifications to work in village clinics. Open recruitment of graduates from higher medical (health) colleges will supplement the rural doctors through channels such as "three supports and one support", which will be managed by township hospitals in a unified way and enjoy the relevant policy treatment of the "three supports and one support" plan. After the expiration of "three supports and one support", township hospitals can go through the recruitment procedures within the establishment according to regulations, continue to be used for rural doctors, and implement "hospital management".
Fourth, innovate the service mode of rural doctors.
(thirteen) to carry out contract services. All localities should explore the contract service between rural doctors and rural residents in light of the actual situation. Rural doctors or teams composed of business backbones of township hospitals (including general practitioners) and rural doctors sign service agreements with rural residents for a certain period of time, establish a relatively stable contractual service relationship, provide agreed basic medical and health services, and charge service fees according to regulations. The service fee is shared by the medical insurance fund, the basic public health service fund and the contracted residents. The specific standards and scope of protection are determined by local governments according to the local medical and health service level, the contracted population structure and the affordability of medical insurance funds and basic public health service funds. Rural doctors who provide contract services shall not charge other fees except for the service fees as required. Rural doctors and rural residents do not have contracted services, and the basic medical service fees provided by rural doctors should be shared by medical insurance funds and individuals through measures such as collecting general medical treatment fees. Counties (cities) will select at least 1 township to carry out pilot projects in 20 15 years, and gradually expand the coverage after summing up experience. Increase the promotion of appropriate technologies, encourage rural doctors to provide personalized health services, and charge fees according to relevant regulations.
(fourteen) the establishment of rural general practice assistant physician system. Add the rural general practice assistant doctor qualification examination to the current practice assistant doctor qualification examination. The qualification examination for rural assistant general practitioners shall be carried out in accordance with the relevant provisions of the national qualification examination for medical practitioners. Those who pass the examination shall be issued with the Qualification Certificate for Rural Assistant General Practitioners, which shall be limited to practice in township hospitals or village clinics. Persons who have obtained the qualification of assistant doctors in rural general practice may participate in the doctor qualification examination as required.
Five, to ensure the reasonable treatment of rural doctors
(fifteen) to ensure the reasonable income of rural doctors. Through the government's purchase of services, we will fully implement compensation policies such as zero subsidy for drugs in village clinics, general medical expenses, basic public health service funds, and operating expenses. Dynamically adjust the subsidy standards for rural doctors in various channels and gradually improve the treatment level of rural doctors. In 20 14 and 20 15, the newly-increased per capita subsidy funds for basic public health services in 5 yuan were all used for rural doctors. In the future, new subsidies for basic public health services will continue to tilt towards rural doctors and strengthen basic public health services at village level. For rural doctors who serve in hard and remote areas and contiguous destitute areas, all localities should appropriately increase subsidies. All localities should bring eligible village clinics and individual clinics into the management of designated medical institutions for medical insurance.
(sixteen) standardize the allocation of funds and supervision methods. Standardize the opening and accounting operation of village clinic accounts, and strengthen supervision over the use of financial subsidies and medical insurance compensation funds. The basic public health service funds, zero-difference drug subsidies and village clinic operation subsidies shall be "quarterly pre-allocated, punched in, assessed and settled" and directly allocated to the village clinic account by the county-level financial department. The medical insurance reimbursement of general medical expenses shall be allocated to the village clinic account by the medical insurance agency on a quarterly basis and settled at the end of the year. The basic public health service funds, zero-margin drug subsidies and general medical expenses are allocated by the person in charge of the village clinic according to the actual work completion of rural doctors, and the primary medical and health institutions are responsible for supervision.
(seventeen) improve the rural doctors' pension policy. Improve the living security mechanism for elderly rural doctors and implement the old-age insurance for in-service rural doctors according to the policy of village cadres. All localities should support and guide qualified rural doctors to participate in the basic old-age insurance for employees according to regulations. For rural doctors who have the qualification of rural doctors, have been engaged in rural doctor work 10 years or more, and have retired from village clinics at the age of 65, a monthly living allowance of not less than 300 yuan will be implemented, and the subsidy funds will be solved by the municipal and county (city, district) governments as a whole. For those who have been engaged in the work of rural doctors for a long time or fail to meet the above conditions, all localities may formulate specific measures according to the financial situation and give appropriate subsidies. The subsidy level shall not exceed that of eligible rural doctors who retire at the age.
Sixth, optimize the practice environment of rural doctors.
(eighteen) to improve the working conditions of rural doctors. Support the construction of village clinics and equipment procurement by means of public construction and private operation and government subsidies. Accelerate information construction, use mobile Internet technology to establish an information system with rural residents' health records and basic diagnosis and treatment as the core and extending to village clinics, and support the instant settlement management of the new rural cooperative medical system, linkage of health records and basic diagnosis and treatment information, performance appraisal, distance training and telemedicine.
(nineteen) to expand the career prospects of rural doctors. Under the same conditions, township hospitals give priority to rural doctors who have obtained the qualifications of practicing doctors and assistant doctors, and further attract practicing doctors, assistant doctors and medical college graduates to work in village clinics.
(20) Improve the risk resolution mechanism. Establish and improve the medical dispute prevention and disposal system covering village clinics. Improve the risk prevention mechanism of rural doctors' practice, extract medical risk fund according to the appropriate proportion of business income of village clinics, and the county-level finance can give appropriate subsidies.
Seven, strengthen organizational leadership.
(twenty-one) to formulate the implementation plan. All localities and relevant departments should take strengthening the construction of rural doctors into the overall consideration of deepening the comprehensive reform of the medical and health system. Municipalities should formulate specific implementation plans before the end of 20 15, and report them to the Provincial Medical Reform Office, the Provincial Health and Family Planning Commission, the Provincial Department of Finance, and the Provincial Department of Human Resources and Social Security for the record.
(twenty-two) the implementation of capital investment. The people's government at the county level shall incorporate the relevant funds for the construction of rural doctors into the fiscal budget. The province supports the construction of rural doctors and further increases subsidies to difficult areas. Finance at all levels should timely and fully allocate funds related to the construction of rural doctors, ensure earmarking, and shall not be withheld, misappropriated or misappropriated.
(twenty-three) to strengthen supervision and guidance. All localities should earnestly safeguard the legitimate rights and interests of rural doctors, and it is strictly forbidden to collect or apportion fees from rural doctors outside the provisions of the state in any name. Rural doctors who have made outstanding achievements in rural preventive health care, medical services and emergency treatment can be commended in accordance with the relevant provisions of the state and the province. All localities and relevant departments should establish supervision and notification mechanisms to ensure the implementation of relevant policies for rural doctors.
General Office of Anhui Provincial People's Government
2015 March 3 1