Role of primary care within the health system | There is no compulsory registration of patients with a general practitioner. Patients can see specialists or the hospital for treatment without a referral. Payment is mostly on a fee-for-service basis. Only in a minority of practices is there a patient list in the sense of an enrolment. Nevertheless, there has been some strengthening of general practice in recent decades, e.g., patients have recently been financially incentivised to specify a GP as the manager of their “global medical record” [29]. |
Legal regulations | The law of 22 April 2019 on good quality practice in health care applies to all health care providers. According to this law, a health professional may only provide health services if he can prove the required skills and experience. For this purpose, he/she must “keep the necessary data, preferably in electronic form, showing that he/she has the required skills and experience” [30, 31]. |
Published aims | CME in Belgium is strongly linked to the development of the accreditation system. This was explicitly created to improve the quality of care through CME on the one hand and to optimise cost efficiency in the health system on the other. |
Actual content | In Belgium, doctors are free to choose the content and provider of their CME training. This is because they are considered to be in the best position to assess their own training needs. To this end, they can attend any accredited continuing education course. Each doctor is expected to earn 20 credits per 12-months accreditation period. However, there are two exceptions: Doctors should specifically address the topics of ethics and economics (at least 3 credits per year). Attendance at at least 2 meetings of a local quality circle is also required [32]. |
Operationalisation | There are hardly any formal requirements for general practice continuing education within (voluntary) medical accreditation. For accrediting training events (with very few exceptions), only content-related aspects such as topic and speaker are considered. Due to these regulations, there are numerous training events in Belgium that are offered by numerous organisers. All relevant information and a list of accredited training events are published online [33]. At the local level, the leaders of the respective quality circles are responsible for coordination. |
Funding and sponsorship | Local quality circles receive limited financial support [34]. Accredited GPs receive a lump sum of 622.61 EURO as compensation for training costs within the 12-month accreditation period. In addition, accredited doctors receive a higher remuneration than non-accredited doctors. Depending on the format, the pharmaceutical industry can finance training events to a limited extent. In general, the current regulations aim to strongly limit the influence of the pharmaceutical industry. |
Evaluation | Only for e-learning courses is there a requirement for compulsory evaluation. The evaluation of other formats is carried out by the organisers on a voluntary basis. The accreditation system itself has only been evaluated once so far, in 2003. The participating GPs believed the accreditation had improved both the quality of the training and the quality of the medical services they provided. It had also increased the number of training courses in which they had participated. |