The planning process regarding inflow in GP training in the Netherlands: between policy and practice.

Greuningen, M. van, Batenburg, R., Velden, L. van der. The planning process regarding inflow in GP training in the Netherlands: between policy and practice.: , 2011. 91 p. Abstract. In: Abstract Book. EHMA Annual Conference 2011: 'Integration in Health and Healthcare', Porto, 22-24 juni 2011.
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Context: Shortages and oversupply of health care personnel are a major concern of policy makers and professional bodies. It is commonly acknowledged manpower planning can be an important instrument to control these fluctuations. In the Netherlands, there has been a long period of experience with health manpower planning (planning of GPs in particular). There is also a long tradition of GP monitoring. In this paper we analyze the role of stakeholders involved in the decision making process regarding GP planning. Methods: We perform a historical policy analysis describing the system of GP manpower planning and its stakeholders from 1970 onwards. For this description, we analyze the trends in planned and realised entry numbers in GP training. In parallel, we describe the stakeholders that were involved in this decision making process and the different policy positions they have. We explain the history of policy decisions made in this period, by interconnecting the trends in the GP labour market and training entry with developments in policy and practice in the same period. Results: Planning for health professionals started in the 1970s, when numerus clausus was introduced. The government explored different approaches to determine this clausus. In the 70s/80s, committees advised the government regarding this topic. Then, the government developed their own planning models. This lasted until 1992, when the government withdrew from this planning. It was left to the professions. In 1999 it was decided to re-centralize the planning, by founding the Capacity Body. A simulation model was introduced, but the policy positions about entry numbers remained a potential point of conflict. Notably, since 2006, the gap between the preferred levels of GP training inflow became smaller as the stakeholders tend to agree to a larger extent with the Capacity Body. Discussion: This paper showed that before the final decision about the inflow in GP training is made, multiple policy processes with stakeholders take place. The results of this study suggest that stakeholders became used to the current system of decision making as governed by the Capacity Body. Still, planning workforces is a matter of stakeholder management. The question therefore remains how solid this process of decision making will be in the future.