Capacity evaluation for general practitioners in Pudong new area of Shanghai: an empirical study

In the Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Health Care System Reforms in 2009 [1], to promote the construction of the four health systems of the public health service system, medical service system, medical insurance system and drug supply system was the most important goal issued, and the gross medical institutions as the base of the Chinese health service system has been playing an important role in public health. Admittedly, the construction of the primary health care is based on the development of the community health service (CHS) in rural China. At the CHS centers (CHSCs) the general practitioners (GPs) provide the local residents with basic health care. The issued guidelines on establishing the communities of GPs have advocated their importance in the national health strategy [2]. Dr. Michael Dixon, National Health Service Alliance chair, once said, “Numerous researches (e.g., from Barbara Starfield and WHO) have shown that a health service predicated on primary care delivers better mortality statistics, improved health, and is more cost effective” [3]. Thus, to build highly qualified GPs is critically important to the development of primary health care, and to promote the construction of GPs is to strengthen the primary healthcare system and improve the general health of Chinese populations.

At present, China encounters such healthcare problems as GPs’ insufficiency [4, 5], under-qualified personnel [6‐11], uneven distribution [12, 13], and serious brain drain [14‐16]. Thus the field studies and policy strategies focusing on in GPs’ human resource equity are of great importance to ensuring the quantity and quality of GPs in China. In March, 2010, the National Development and Reform Commission (NDRC), the National Health and Family Planning Commission (NHFPC), the State Commission Office of Public Sectors Reform (SCOPSR), the Ministry of Education (ME), the Ministry of Finance (MF), the Ministry of Human Resources and Social Security (MHRSS) jointly issued the Construction Planning of GP-Focused Primary Health Care Teams, which consisted of three major tasks of cultivation, employment and management to have built a community of 300,000 across the country by 2020 to address the requirements of primary health care [17]. Hereinto, an emphasis was placed on the establishment of ability-and-performance-oriented and social-recognition-focused mechanism of qualification evaluation targeted at the primary care personnel, because such an endeavor would help reduce inequity of health workforce in the provision of primary health care.

Over the world, more than 50 countries have health care systems based on the GP model [18]. Some of those countries such as UK, Germany and USA have developed advanced GP management system which integrates capacity evaluation with pre-occupation schooling and post-occupation training, performance appraisal and incentive mechanism throughout a GP’s entire career [19‐23]. Different from those developed countries in the world, most countries are just at the beginning, trying to establish such a management system with its own characteristics. As an important part of medical practice in China, traditional Chinese medicine (TCM) plays a vital role in delivering primary health care. At the CHSC, the GPs who are engaged in the integration of TCM and western medicine (WM) can be expected to have routinely a holistic view and evidence-based skill in diagnosing and treating common diseases as well as in practicing rehabilitation and prevention. Technically, these types of GPs are certificated physicians of general medicine; therefore, they are equally treated as those counterparts of WM.

Previous investigations have presented multiple perspectives on GPs’ capacity evaluation [24‐27]. In China, there have been few studies discussing GPs’ necessary ability elements [28] and the establishment of evaluation index system [7, 29]. Obviously, few studies have empirically evaluated GPs’ capacity in terms of ability and performance and recognition.

In 2014, a newly developed model of GP qualification examination, called the GP’s Theoretical and Practical Examination (GPTPE), was initiated in Pudong New Area of Shanghai, China, which was characterized by ability/performance-oriented evaluation so that the theoretical knowledge and practical capacity of the GPs could be evaluated at their working CHSC and the ways of alliance for other existing continuing medical education (CME) and clinical performance evaluation as well as GPs’ incentive mechanisms could be explored.

In the current study, we analyzed the first two-year data of Pudong-New-Area-based GPTPE (2014–2015) with a view to getting a deep insight into the GP community so as to identify barriers in particular to its further development, as empirical evidence for the national establishment of GP evaluation mechanism as well as for the promotion of equity in the human resource for the delivery of primary health care across the country.

As empirical evidence for the national establishment of GP evaluation mechanism as well as for the promotion of equity in the human resource for the delivery of primary health care across the country, the newly developed GPTPE in Pudong New Area is of profound importance in building qualified GPs in China. It can be concluded from the current study on the GPTPE to empirically evaluate GPs’ competence and performance, the resource of qualified GPs was not sufficient at CHSCs, which reflected the urgency of building qualified GPs to address the growing demand for CHS. As a preliminary study, it needs further research to explore ways of alliance for the existing CME, evaluating model and incentive mechanism in building qualified GPs.