Gp in Europe



The National Health Service (NHS) was first established in 1978 (Law 833) and subsequently partly amended in 1992 (DL. 502) and 1993 (DL. 517). It is a comprehensive universal NHS providing free care for all citizens from birth to death. A new law is now being discussed.It is based on a National Minister of Health, with national capitation funding through the direct control of the 20 regional health authorities. 

Direct financial responsibility is held by the local district authorities, now transformed into trusts. Most hospitals are directly managed by the district authorities. The biggest hospitals, though, are now Trusts themselves with financial autonomy.Apart from publicly owned health resorts, care is also provided by agreement with private hospitals and specialists.General practice is granted free of charge to all citizens. All district inhabitants must choose their general practitioner (GP). Italian general practice is list-based. 

Almost all prescriptions and referrals are decided by GPs who hold the entire clinical responsibility for the patients. There are more than 56,000 GPs in Italy.GPs are independent unsupervised medical practitioners paid by the district authority on capitation (80 per cent) fee-for-service and allowances (20 per cent). Terms of service are contracted and agreed between GPs and the regional authorities every three years, on a national basis.A new general practitioner's agreement is now being negotiated.GPs are in charge between Sam and 8pm in private practices.Out-of-hours services are performed by the National Deputising Service with more than 20,000 doctors. They provide urgent primary care during night hours, Saturday afternoons and Sundays and holidays. 

The new agreement provides possibilities of innovation, eg, there is the possibility to create associations between GPs.Terms of service for GPs include office and home visits, diagnoses and treatment, prevention and screening as well as health education. Working in general practice excludes any other medical appointment by the NHS. Private medical activity is allowed.Vocational training is now well established.The Ordine dei Medici (FNOMCeO) exercises compulsory control on issues related to deontology and medical ethics.Hospital care is also provided free of charge. The Government introduced a new Diagnostic Related Groups (DRG) system whose application is at the beginning.On the basis of income, patients pay a contribution (co-payments) for specialist services and for diagnostic procedure.The drug formulary includes free drugs (first choice) drug with co-payments (second choice drugs) and marginally effective drugs (entirely charged to patients).Authority on capitation (80 percent) and with an overall medical population of more than 31 5,000 doctors.Group work and team practices are rapidly developing in general practice.


The remuneration of general practitioners

A GP is allowed a maximum of 1,500 (1,800 in some special cases) patients on his or her list. This effectively places a constraint on NHS income, since the payment system is a capitation one. NHS earnings are therefore around 60,000 per annum and include around 20 per cent as reimbursement for expenses. All doctors are allowed to work privately with limitations, except for GPs who are not free to work privately with the patients on their list.



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