National Health Commission Reports Progress on Family Doctor Contract Services and Nursing Workforce Development Ahead of World Family Doctor Day and International Nurses Day

VCBeat News—On the morning of May 10, 2017, the National Health and Family Planning Commission held a regular press conference, primarily to introduce the progress of family doctor contracted services in China and the development of nursing care nationwide. The conference will highlight key advancements in China’s family doctor contracted services, showcase distinctive local models, and report on achieved outcomes, while also announcing the development targets for family doctor contracted services for the year.

May 19 is World Family Doctor Day. Promoting family doctor contract services is a key task in our healthcare reform to better serve the public. Last May, the Healthcare Reform Office of the State Council, in conjunction with relevant departments, jointly issued the "Guiding Opinions on Advancing Family Doctor Contract Services." Meanwhile, May 12 marks International Nurses Day. The press conference also highlighted the achievements made in China’s nursing sector and outlined the development goals for the nursing profession during the 13th Five-Year Plan period. Key tasks proposed include strengthening the nursing workforce, improving the quality of nursing care, enhancing scientific management in nursing, and expanding nursing services.

Today’s meeting featured Liu Liqun, Deputy Inspector-General of the Department of Primary Health Care under the National Health and Family Planning Commission (NHFPC), and Wu Qianyu, Deputy Director of the Shanghai Municipal Health and Family Planning Commission, who presented on the implementation of family doctor contract services. Additionally, Guo Yanhong, Deputy Director of the Bureau of Medical Administration under the NHFPC, provided an overview of nursing care in China.

In May 2016, the Office of the State Council Leading Group for Healthcare Reform, together with six other ministries and commissions, jointly issued the “Guiding Opinions on Advancing Family Doctor Contract Services,” marking the official and comprehensive launch of family doctor contract services. Domestic and international experience demonstrates that family doctor contract services constitute an effective healthcare delivery model. This approach helps meet residents’ healthcare needs, improves the overall efficiency of the healthcare service system, and curbs the rapid rise in medical expenditures. Family doctor contract services serve as a critical foundation for advancing the tiered diagnosis and treatment system, an important pathway to fostering harmonious doctor–patient relationships, and a key measure to address new health challenges posed by population aging and shifts in disease patterns.

Currently,Nationwide, the work on family doctor contract services is progressing in an orderly manner. Twenty-seven provinces (autonomous regions and municipalities) have issued guidance documents or implementation plans to promote these services, yielding initial results overall. 

First, the policy framework for family doctor contract services has been preliminarily established. Relevant departments and local authorities have issued a series of policy documents, forming a system of family doctor contract services with Chinese characteristics.

Second, the family doctor contract service platform has been continuously improved. The construction of urban and rural primary healthcare service systems has been strengthened, basically achieving the goal of having a village clinic in every village, a township health center in every township, and one community health service center in each sub-district, enabling residents to access medical and healthcare services nearby.

Third, the service capacity of family doctors has been strengthened. Vigorous efforts have been made to enhance standardized training for general practitioners through the “5+3” model and to cultivate assistant general practitioners via the “3+2” model. The project for tuition-free medical students with directed rural employment has been implemented, pilot programs for special posts for general practitioners have been launched, examinations for rural assistant licensed general practitioners have been advanced, and multi-site practice for physicians has been promoted, thereby effectively enriching the workforce of family doctors.

Fourth, the public’s sense of gain has been enhanced. In regions where family doctor contract services have been implemented effectively, the downward shift of outpatient visits among urban and rural residents is gradually becoming evident, the benefits of health management are steadily improving, and the concepts of “family doctors as friends” and the “caring companion” service model have gained widespread acceptance.

Since 2011, in accordance with the directions and principles established by the central government, various regions have carried out extensive, context-specific explorations in family doctor contract services, accumulating valuable experience. In summary, five major models and sets of best practices have emerged.

First is Shanghai’s “1+1+1” contracted service model. Under this model, residents, after signing up with a family doctor at a community health service center, further contract with one district-level medical institution and one municipal-level medical institution, thereby forming a “1+1+1” contracting combination.

Second is the “Basic Package + Personalized Package” contracted service model in Dafeng District, Yancheng, Jiangsu Province. This model provides contracted residents with free basic services, including essential public health and primary medical care, while offering personalized services tailored to specific groups such as the elderly, children, and patients with chronic diseases, thereby creating a service package characterized by a “tiered structure, reasonable variety, distinct features, and rich content.”

Third is the “integrated medical, nursing, and elderly care” contracted service model in Hangzhou, Zhejiang Province. Through policy coordination among health, finance, medical insurance, pricing, and personnel compensation sectors, a series of incentive mechanisms have been introduced to ensure that family doctors provide “integrated medical, nursing, and elderly care” services to contracted residents.

Fourth is the “Three-Physician Co-Management” contracted service model in Xiamen, Fujian Province. Focusing on chronic diseases as a breakthrough point and prioritizing the elderly, this model establishes “Three-Physician Co-Management” teams comprising primary care family physicians, health managers, and specialists from tertiary hospitals to provide contracted services to residents.

5. The “capitation-based global prepayment” contracted service model implemented in Dingyuan County and other counties in Anhui Province. A three-tiered medical consortium spanning county, township, and village levels was established. Through capitation-based global prepayment of urban and rural resident basic medical insurance funds, a distribution and incentive mechanism featuring shared responsibilities and shared benefits was created. This approach has facilitated the downward referral of patients to primary care institutions and linked village doctors’ income to the number, quality, and outcomes of their contracted services.

In April this year, the National Health and Family Planning Commission (NHFPC) convened a national on-site promotion meeting for family doctor contract services in Shanghai, summarizing and promoting work experiences from various regions. Recently, the NHFPC and the State Council’s Office of Healthcare Reform jointly issued the “Notice on Effectively Implementing Family Doctor Contract Services in 2017,” deploying tasks for the current year and outlining ten key requirements.The 2017 goals for family doctor contract services were: to implement family doctor contract services in more than 85% of prefecture-level cities across China, achieve a population coverage rate of over 30%, attain a contract service coverage rate of over 60% for key populations, and strive to achieve full coverage for individuals living in poverty and special family planning households.

The meeting proposed that to advance the work of family doctor contract services, it is necessary to focus on resolving the issue of “two types of enthusiasm.”

First, it is necessary to mobilize the public's enthusiasm for participating in contracted services. Localities are encouraged to proceed based on actual conditions,Provide differentiated services for enrolled residents, including outpatient appointment scheduling, prioritized referrals, extended prescriptions for chronic diseases, home nursing care, and health management. In terms of medical insurance, incentives such as increased reimbursement rates and cumulative calculation of deductibles are implemented to encourage residents to actively enroll in the program.Meanwhile, we must continuously improve service conditions at the primary care level, strengthen vertical coordination between primary care institutions and hospitals, and enable contracted residents to access high-quality medical services close to home. This year, our Commission launched the “Year for Enhancing Primary Healthcare Service Capacity” initiative, undertaking efforts to build township health centers that meet public expectations and community health service centers demonstrating exemplary service quality, thereby further enhancing primary care service capacity and bolstering public trust.

Second, it is necessary to mobilize the enthusiasm of medical personnel to carry out contracted services.Improve the performance-based salary system in accordance with the “Two Permissibles” policy: permit medical and health institutions to exceed the current wage control levels applicable to public institutions, and allow revenue from medical services—after deducting costs and allocating required funds—to be primarily used for staff incentives, thereby fully leveraging the positive guiding role of performance-based distribution. Priority in staffing quotas, personnel recruitment, on-the-job training, awards and recognitions, and professional title promotion shall be given to personnel engaged in contracted service delivery, so as to create a favorable professional development environment for family doctors.

“Thirty percent treatment, seventy percent nursing.” While nurses and nursing work may appear ordinary, they play an irreplaceable role in assisting diagnosis and treatment, saving lives, maintaining health, alleviating suffering, promoting recovery, and fostering harmony between doctors and patients. Whether in daily medical care or during critical moments when major natural disasters, disease outbreaks, and other threats endanger public health, nursing professionals have faithfully fulfilled their duties, saved lives, and demonstrated dedication and professionalism. They have achieved extraordinary accomplishments in ordinary positions, earning widespread social acclaim, patient appreciation, and government recognition.

In recent years, under the strong leadership of the CPC Central Committee and the State Council, China has actively promoted the rapid development of nursing, centering on “the health of the people” and focusing on two main threads: “strengthening the nursing workforce” and “meeting the public’s health needs,” achieving remarkable results. Relevant data on China’s nursing sector were also released at the conference.

I. The nursing workforce continues to expand, with improvements in quality and professional competence.By the end of 2016, the total number of registered nurses in China reached 3.507 million, accounting for 42% of all professional technical personnel in health and family planning, representing a 71.2% increase from 2010. The number of nurses per 1,000 population rose from 1.52 in 2010 to 2.54 in 2016, while the national hospital nurse-to-physician ratio improved from 1:1.16 in 2010 to 1:1.45 in 2016.The magnitude of growth in these indicators represents the largest increase recorded across all historical periods in China.In 2016, the number of nurses engaged in nursing work at primary healthcare institutions reached 696,000, with those holding an associate degree or higher accounting for 65.1% of the total.Nurses’ professional competence and technical expertise have steadily improved, their service capabilities have continuously enhanced, and they have played a significant role in medical treatment and rescue efforts during major public health emergencies.

II. Nursing services have been continuously improved to better align with societal and public needs. Medical institutions at all levels and nurses across the board provide standardized, professional, and high-quality nursing care to patients, thereby alleviating their suffering, accelerating recovery, enhancing medical efficiency and effectiveness, and meeting the physical and mental health needs of the public. By the end of 2016, high-quality nursing services had achieved full coverage in tertiary hospitals, with 88.2% of secondary hospitals implementing such services. Nationwide, an increasing number of hospitals are actively promoting high-quality nursing care, benefiting a growing segment of the population.

III. Improvement in Nursing Management Standards and Gradual Mobilization of Nurses’ EnthusiasmIn accordance with the requirements for deepening healthcare reform and advancing nursing reform and development, regions and medical institutions have continuously innovated and reformed nursing management systems and mechanisms. They have explored and implemented practices in nurse human resource allocation, continuous improvement of nursing quality, scientific performance evaluation, and compensation distribution, achieving certain results. Measures such as establishing special allowances for nursing positions, increasing night-shift pay, improving remuneration for frontline nurses, and enhancing working conditions have been adopted to strive to create a favorable professional development environment for nurses. Income distribution, title promotion, awards, and evaluations for nurses have been tilted toward clinical frontline staff, adhering to the principles of “more pay for more work” and “higher rewards for better performance.” These efforts have helped stabilize the frontline clinical nursing workforce and mobilized nurses’ enthusiasm for their work.

IV. The scope of nursing services continues to expand, meeting the multi-level health needs of the public. To proactively adapt to changes in the disease spectrum and the process of population aging, some regions and medical institutions have gradually extended nursing services into communities and homes, actively innovating service models to provide elderly care, chronic disease management, long-term care, rehabilitation promotion, and palliative care, thereby further satisfying the diverse and multi-level health service needs of the people.