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Doctors consider striking over new night-time on-call rules

09:13 19/04/2023

Belgium’s general practitioners are considering going on strike in protest against new measures proposed by the country’s federal health minister Frank Vandenbroucke.

Vandenbroucke wants to ensure that the 1733 on-call medical service is available around the clock, RTL reports, which means that doctors will have to divide night shifts amongst themselves amid a staff shortage.

The new rules stipulate that night shifts should be covered by two doctors – one at a medical post for consultations and another available for home visits.

But union leaders say this system is difficult to put in place.

“It’s not easy to find doctors who want to be available for a shift, and it's even more difficult to put a doctor on duty who won't do anything,” said Luc Herry, president of Absym, the Belgian Association of Medical Unions.

“Two doctors to manage perhaps just two cases per night is still a lot of doctors. Finding 30 to 40 more doctors every day is going to be mission impossible.”

The 1733 service, which normally handles non-emergency calls, is no longer able to provide night shifts due to an ongoing shortage of staff. Vandenbroucke wants GPs to compensate for this lack of staff.

There are about 30 on-call positions in Wallonia alone, estimated to handle an average of just over one call per 100,000 inhabitants.

“In Wallonia there were agreements between doctors to see patients at night only in certain cases - intolerable pain, death certificates, nursing home residents and palliative care patients,” Vandenbroucke said.

“This has never been an official directive. 1733 will now follow the official guidelines, which means that some patients with sufficient levels of urgency can also be seen during the night.”

Faced with these new measures, GPs say they are ready to go on strike.

“I believe that doctors, colleagues, will perhaps go so far as to block this night shift, though this is not our wish,” said Herry.

Vandenbroucke said discussions are ongoing and added that he wants to find long-term structural solutions together with the GPs.

Even without the added burden of mandatory night-shifts for the 1733 hotline, Belgian doctors are struggling – 14% of GPs in Brussels have stopped taking new patients, compared to 17% for the country, as a result of being overwhelmed by demand.

GPs cite additional administrative tasks that have increased their workload since the pandemic, and a large number of GPs are also retiring without enough young doctors entering the workforce to replace them.

The FPS Public Health’s medical supply planning committee organised a new survey to provide a better insight into the number of hours worked per week by full-time GPs and how these are filled. The survey also falls within the framework of determining the quota for doctors for 2029.

Among other findings, the survey indicated vast differences between provinces when it comes to freezes on accepting new patients and the average number of hours worked each week.

In West Flanders, for example, only 8% of GPs report refusing new patients, compared to 22% in nearby East Flanders.

And while Flemish and Walloon GPs have an average working week of 50 hours, that figure is 42 hours for Brussels GPs.

Another difference is the fact that Brussels GPs more often work in a flat-rate medical centre (where a fixed amount is paid per registered patient) where the workload is perceived to be lower.

GPs in Brussels also tend to have fewer waiting hours, and spend less time on average travelling. However, they do spend more time communicating with patients and report struggling with a language barrier more often.

Written by Helen Lyons