Dear Mrs. Robijn, Our GP has stopped his practice and has a successor, a still young doctor. He is part of a group practice. I hardly ever come for a consultation, the last time was certainly a year ago. I am fortunately blessed with good health, but that may change, given my age, I will be 80 in May. There are also two female GPs in this group practice, for years. I’ve had a consultation with one of them in the past. Now I would much rather take one of these two female GPs as my primary care physician, especially considering my age. Now I happened to hear that this group of general practitioners has agreed among themselves not to allow changes, unless in very exceptional circumstances. I really don’t think this is possible, in the end there is a free choice of GP in the Netherlands. One of the exceptions is when having a specific woman complaint. I don’t have one (yet?), but to be honest I would much rather choose a female GP now. When we moved to this place in 1978, I went to this group practice because it was the closest. You could then go on a practical visit to whomever you wanted and I went to whoever I could go to first. Over time – mainly due to teething problems of the children (3) – we developed a good relationship with one of them. This doctor was still young at the time, but we ended up having him for over thirty years. I went to his successor’s introduction day, but as nice as he is, I would much rather have a female GP now. It really doesn’t seem like an exaggeration at my age! So far I have not needed a doctor since our previous GP left. How can I best tackle this now? I look forward to your reply with interest. Sincerely, M. Smits-Jansen
M. Smits-Jansen
Roermond
Hilke Robijn, medical sociologist
It is best to follow the KNMG guideline to answer your question. The KNMG is an interest group for doctors and has been committed to the quality of the profession of doctors and public health since its foundation (1849). The organization focuses on files that transcend the various professional associations and are therefore relevant for all doctors. Doctors in principle follow these guidelines as agreed within their own interest group.
The KNMG’s rules of conduct for doctors state ‘the doctor respects the patient’s right to free physician choices.’ This means that patients have the right to choose who they want to be treated or examined by. This right is a valuable asset. After all, patients end up in situations that are intimate and vulnerable to them, and it is therefore important that they have care providers with whom they feel comfortable. Trust between therapist and patient also improves the quality of the treatment.
No unlimited right
However, the right to free choice is not an unlimited right. The free choice of doctors can be limited by various factors (limitations in insured entitlements, a limited capacity of GPs per municipality or region, etc.).
Patient Responsibility
Since free choice of physician is primarily a patient’s right, the responsibility for choosing lies with the patient. This means that the patient must orientate himself in good time with the available care providers and must also make the choice for a particular care provider known in good time – when making an appointment. If the patient waits to express his preference until the treatment or examination will actually take place, the doctor or institution will not and will not be able to respond (KNMG position 2008).
You are therefore fully entitled to your own choice of doctor. You have made your choice known to the general practitioner in good time. You are fully entitled according to all guidelines.
Practical problems
However, your desire to change GPs may run into practical difficulties. The private interest association of general practitioners, the LHV, provides arguments for quality guarantees: care must be able to be provided responsibly. The GP of your choice may refuse to accept you as a new patient if:
• you live too far away
• you do not indicate your preference in time
• his practice is full
• he recently provided you with help as an observer of your old general practitioner.
The Netherlands Competition Authority (Nma) has investigated the anti-competitive agreements between general practitioners and their influence on the right to choose a general practitioner. This has shown that mutual agreements and agreements between general practitioners that restrict competition are inadmissible. The LHV subsequently amended the guidelines in response to the Nma’s ruling. Blocking the free choice of doctors is contrary to the competition law.
letter
You can talk to the relevant general practitioner to get out of the impasse or send him a letter pointing out the decision of the NMa and the policy of the LHV.
If your GP continues to maintain practice and you are not allowed to transfer to the GP of your choice, you can consider contacting a Healthcare interest organizationeg client interests (they also have sample letters) or to submit a complaint to the NMa.
I hope you manage it successfully, because a good relationship with your GP provides you with a lot of health, in the broadest sense of the word.
Hilke Robijn, care sociologist
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