The National Association of General Practitioners (LHV)
The Netherlands, a small country in northwest Europe with 16 million inhabitants, has a relatively good system of healthcare. One of the main reasons is the important position of the general practitioner in this system. He or she is the gatekeeper and centre of the network of professional and other institutions on behalf of the patient.Not only in defence of their common interests but also in order to maintain high standards in general practice, general practitioners have built themselves a strong, well equipped and highly esteemed organisation: the Landelijke Huisartsen Vereniging (LHV), The National Association of General Practitioners. Formerly part of the Royal Dutch Medical Association (KNMG) and since the latter is a federation, the LHV is a member thereof. About 90 per cent of the 7,000 doctors in general practice are members of the LHV. Membership is voluntary.The National Association of General Practitioners is responsible for creating the preconditions for the delivery of good quality primary care to the whole population throughout The Netherlands, 24 hours a day, seven days a week.
The structure of the Association
Each and every general practitioner participates in a general practitioners' circle. These circles consist of a group of six to ten colleagues who agree to regulate locum duties, continuing training, running of the practice and peer review among themselves. These agreements are laid down in a regulation.These circles of general practitioners are represented in the Regional Association of General Practitioners (RHV). This body concerns itself with local matters which have an impact on the work of the genera] practitioner: for example, agreements with local hospitals, medical specialists and other healthcare workers.In addition, the RHV sends representatives to the LHV Members' Meeting, the highest institution of the LHV.There are more than 80 RHVs altogether.The 23 District Associations of General Practitioners (DHVs) serve as an umbrella for the regional associations and act also as a go-between for the regional and the national levels. The establishment of new practices, the contents of the care package and collaboration between care workers are discussed and negotiated at this level. The district associations negotiate with insurance organisations and are the focal point for questions concerning the profession in the region.The LHV is working on a national (and international) level and is charged with policy matters affecting the entire profession. This policy is set by the Governing Board and is endorsed in the Members' Meeting.The Members' Meeting convenes about seven times a year.A separate meeting is held to deal with matters relating to dispensaries and the 750 dispensing general practitioners.The Executive Board of the LHV is directly elected by the Members' Meeting. The Governing Board consists of the chairpersons of the district associations (DHVs) and the Executive Board.The RHV, DHV and LHV administrate a common policy through these channels.All members of the boards are in general practice.The national headquarters of the LHV, which is headed by a general manager, is in Utrecht. The office employs over 40 people and is housed in the Domus Medica building, where the KNMG and the Dutch College of General Practitioners (NHG) also have their offices.At district level there is an office with a general manager, secretariat and, in some cases, one or more policy assistants. The district office actively supports activities aimed at the promotion of expertise.The LHV— regionally and nationally — has 350 employees on its staff altogether. One-third of this number combines these duties with general practice. A large number of the others work part-time.
Tasks of the association
The three main tasks of the professional association are to represent the interests of members, to provide support and to promote expertise among them. The work of the association is funded by the contributions of its members and the last two tasks are chiefly paid by subsidies of the health insurance companies (private and social). The professional organisation is responsible for the organisation and continuing training of general practitioners in the Netherlands. The NHG, which is closely affiliated to, and often works in collaboration with the LHV, takes care of medical questions.
Cost of healthcare in The Netherlands
Hospital care 29.2%
Services for elderly people 18.4%
for handicapped people 8.8%
Services for mental healthcare 7.0%
General practice 3.8%
Specialist care 4.2%
Pharmaceutical care 10.9%
Dental care 4.0%
Paramedical care 2.4%
Management, administration 4.2%
General practitioners have agreed to couple re-registration to continuing training activities.The programme for the promotion of expertise has been designed to fit in well with the need for continuing training in general practice. Local work groups organise courses which reflect the desires of the local professional groups and fit into a programme that is planned and co-ordinated at national level. The work groups are chaired by general practitioners who are employed part time by the LHV especially for this purpose.