INTRODUCTION
In the last decade GPs in the Netherlands have been confronted with an increasing workload and administrative pressure, as is the case in the UK.1–3 Traditionally, general practice holds a firm position in the Dutch healthcare system, addressing 90% of healthcare problems using only 3% of the national healthcare budget. The accessibility, the broad expertise of GPs, and the longitudinal care are highly appreciated by patients, and both government and health insurance companies consider general practice essential for sustainable and affordable health care.4
However, major healthcare system changes in the last years have led to a growing demand for GPs’ services, as a large part of the care traditionally delivered by hospitals and outpatient clinics, such as diabetes care, chronic obstructive pulmonary disease, and heart failure care, is being transferred to general practice.5 Preventive tasks, for example, cardiovascular risk management and lifestyle coaching, as well as proactive care for the old and mental health care, have been added to the workload of general practice. Based on data from 34 countries gathered in the Quality and costs of primary care in Europe (QUALICOPC) project, Schäfer et al showed that the workload and diversity of duties of Dutch GPs are among the highest.6,7 In addition, the workforce is changing, with a new generation of GPs trying to restrict their working hours, pursuing a better balance between professional and private life.
One of the tasks most jeopardised is the out-of-hours GP emergency service in which all practices participate. Because of the increasing workload during office hours, many GPs are reluctant to participate in this emergency service, jeopardising the sustainability of the out-of-hours service. Although every GP in the Netherlands has to do a minimal number of shifts for the GP registration, this is not enough …