Commentary: preparing primary care for the future - perspectives from the Netherlands, England, USA and lessons for Germany.

BACKGROUND

Like the Netherlands, England, and the USA, Germany is facing challenges posed by globalisation, medical and technological progress, and demographic change. Strategies to meet these challenges and practice models in these countries vary because they depend on the organisation and funding of the health care system and the traditional role of primary care. However, some of the approaches from other countries and health care systems may be transferable to the German situation.

METHOD

We describe the background and the main challenges for primary care in Germany. Subsequently, we review the strategies pursued to prepare primary care for the future in the Netherlands, England, and the USA and analyse their applicability for Germany.

RESULTS

All countries reviewed struggle with the improvement of cooperation and integration of care for patients with chronic illness. Proposed changes concern the organisation and funding of primary care, including cooperation in multidisciplinary teams within larger organisations such as virtual provider networks, GP-led health centres, or polyclinics which focus on the management of the patient population they are accountable for. This can be aided by national standards of care, care pathways, and guidelines. An appropriate funding model should provide incentives for population management which includes the whole team, e.g. through a mixture of capitation, fee-for-service, and pay-for-performance.

CONCLUSION

The strategies pursued in other countries suggest how primary care in Germany could be restructured and improved to prepare for future challenges. However, in addition to considerable changes in organisation, funding, and incentives, educational, cultural, and other conditions need to be taken into account as well, especially in the case of forming multidisciplinary care teams. Improvement collaboratives and a national programme of practice coaches could be a way to prepare GP practices for and help them implement such major changes.