Chuan ban fa [2015] No.74

Municipal (state) people's governments, provincial government departments and directly affiliated institutions:

In order to fully implement the "Implementation Opinions of the General Office of the State Council on Further Strengthening the Construction of Rural Doctors" (Guo Ban Fa [20 15] 13) and effectively build a rural medical and health service network, combined with the actual situation in our province, we now put forward the following implementation opinions on further strengthening the construction of rural doctors in our province.

I. Overall Requirements and Main Objectives

(1) General requirements. Adhere to the basic, strong grassroots, and build mechanisms. In order to adapt to the economic and social development of our province and the long-term construction of the basic medical and health system, we should reform the service mode and incentive mechanism of rural doctors, implement and improve the salary, pension and training policies of rural doctors, strengthen supervision, stabilize and optimize the team of rural doctors, and comprehensively improve the level of village-level medical and health services.

(2) Main objectives. Through 10 years' efforts, strive for rural doctors with secondary school education or above, and gradually have the qualifications of practicing assistant doctors or above, basically build a team of high-quality and adaptable rural doctors, promote the establishment of the system of first diagnosis and graded diagnosis and treatment at the grassroots level, and better serve the health of rural residents.

Second, the main task

(1) Stabilize and optimize the team of rural doctors.

1. Rational allocation of rural doctors. Rural doctors are mainly responsible for providing public health and basic medical services for rural residents, and undertaking other medical and health services related work entrusted by the administrative department of health and family planning. All localities should comprehensively consider the service population, service status, expected demand and regional conditions and rationally allocate rural doctors. In principle, rural doctors are equipped according to the standard of 1- 1.2 per thousand serving population. Strict access to rural doctors, medical staff practicing in village clinics must have corresponding qualifications and register according to regulations.

2. Improve the attractiveness of rural doctors. Encourage all localities to carry out pilot projects of comprehensive rural management in light of actual conditions. Township health centers can recruit qualified practicing (assistant) doctors working in village clinics according to regulations, send them to serve in village clinics, and explore the management and use mode of "rural employment and village use". Strengthen the unified and standardized management of township hospitals on the personnel, business, medical equipment, finance and performance appraisal of village clinics, and promote township hospitals to lead village clinics. Establish a system of assistant doctors in rural general practice, and do a good job in connecting the construction of rural doctors and general practitioners. Persons who have obtained the qualification of assistant doctors in rural general practice may participate in the doctor qualification examination as required.

3 to ensure the reasonable income and treatment of rural doctors. All localities should comprehensively consider the actual situation, service capacity and service cost of rural doctors, and adopt the way of government purchasing services to ensure the reasonable income level of rural doctors. With the development of economy and society, we will dynamically adjust the subsidy standards for rural doctors in various channels and gradually improve the treatment level of rural doctors. For the basic public health services provided by rural doctors, according to the approved tasks and assessment results, the corresponding basic public health service funds shall be allocated to rural doctors. In 20 14 and 20 15, the subsidies for rural basic public health services were added, and all of them were used by rural doctors in 5 yuan. In the future, the new subsidies for basic public health services will continue to tilt towards rural doctors and strengthen village-level basic public health services. City (state) county government should support and guide school-age rural doctors to participate in the basic old-age insurance for employees in accordance with the regulations, and those who meet the retirement conditions receive pensions in accordance with the regulations. Rural doctors can also participate in the basic old-age insurance for urban and rural residents in the household registration. Establish the withdrawal mechanism of rural doctors. In principle, rural doctors who have reached the age of 65 in the previous year should resign as rural doctors, and the maximum age is 70.

4. Change the service mode of rural doctors. Comprehensively promote rural doctors' contract service, establish a relatively stable contract service relationship, provide agreed basic medical and health services, and collect service fees according to regulations. The service fee is shared by the medical insurance fund, the basic public health service fund and the contracted residents. The specific standards and scope of protection are determined by each city (state) according to the local medical and health service level, the contracted population structure and the affordability of medical insurance funds and basic public health service funds.

5. Improve the practice environment of rural doctors. All localities should rely on the construction of rural public service platforms and other projects, and take public construction and private operation, government subsidies and other ways to further support the construction of village clinics and the purchase of equipment. Accelerate the informatization construction, extend the information system with rural residents' health records and basic diagnosis and treatment as the core to village clinics, and support the real-time settlement management of the new rural cooperative medical system, linkage between health records and basic diagnosis and treatment information, performance appraisal, remote training and telemedicine. Establish a medical risk sharing mechanism suitable for the characteristics of rural doctors, and take various ways such as medical and health institutions in the county to participate in medical liability insurance as a whole to effectively resolve the practice risks of rural doctors. To carry out TCM services, basic TCM diagnosis and treatment equipment should be equipped.

(two) to increase the training of primary health personnel.

6. Strengthen the training of rural primary medical students. Strengthen the free training of rural order-oriented medical students, focusing on the free training of three-year secondary and higher vocational medical students in village clinics. Free medical students mainly recruit rural students. Organize qualified on-the-job rural doctors to take the examinations prescribed by the state, enter medical colleges and universities to receive medical education, and improve the overall academic level. In accordance with the provisions to participate in academic education and obtain the corresponding qualifications of rural doctors, the government can give appropriate subsidies to their tuition fees, and the specific subsidy standards are formulated by the municipal (state) government according to local conditions.

7. Promote standardized training for general practitioners. According to the Implementation Opinions of Sichuan Provincial People's Government on Establishing the General Practitioner System (SJFFA [2065438+02] No.26), the newly recruited staff of urban community health service institutions and rural medical and health institutions are given priority to receive training in national or provincial general practitioner training bases, and general practitioners and assistant general practitioners are trained in the form of "5+3" and "3+2".

8. On-the-job training for primary health personnel. All localities should rely on county-level medical and health institutions or conditional central township hospitals to carry out on-the-job training for rural doctors. Rural doctors receive free training not less than 2 times a year, and the cumulative training time is not less than 2 weeks; City (state) should plan to send outstanding rural doctors with the qualification of practicing doctors or practicing assistant doctors to provincial and municipal hospitals for free training; Rural doctors go to county-level medical and health institutions or conditional central township hospitals for full-time study every 3-5 years, and the study time is not less than 1 month in principle. Rural doctors should learn Chinese medicine knowledge and use Chinese medicine skills to prevent and treat diseases. Medical college graduates working in village clinics have priority to participate in standardized training for residents.

(3) Innovating the use mechanism of primary health personnel.

9. Improve the performance appraisal and financial subsidy policies of primary health care institutions. Improve the distribution method of performance appraisal, strengthen the salary based on post and performance, increase the internal distribution of the unit, tilt to the front-line backbone medical staff, and truly establish the distribution system of more work and more pay. In accordance with the regulations, township subsidies shall be given to the staff of township medical and health institutions, and grassroots medical personnel shall be encouraged to take root in grassroots services for a long time. Improve the way of financial subsidies, implement measures such as linking approved tasks with fixed subsidies and timely and dynamic adjustment, and increase the proportion of personnel expenditures to business expenditures. The funds for basic public health service projects shall be managed by special accounts and used for special purposes, and special audit and supervision on the implementation and use of funds shall be strengthened. Encourage all localities to explore and establish a new mechanism for purchasing basic public health services.

10. Intensify recruitment and improve the professional title policy. All localities should pay close attention to enriching a number of professional and technical personnel in primary health institutions in counties and townships. Under the premise of meeting the basic responsibilities of post conditions, the registration conditions can be appropriately relaxed to reduce the proportion of examination; The urgent need for shortage of health professional and technical personnel, according to the relevant provisions of the implementation of recruitment assessment. Doctors and nurses working in community health service institutions can take the national unified examination of general practice and community nursing with intermediate qualification of health technology 1 year in advance.

1 1. Strengthen counterpart support for urban and rural health. Organize key clinical specialties in urban medical institutions above the second level, help the construction of characteristic departments in urban and rural grassroots medical and health institutions, cultivate a number of characteristic technologies and special disease projects suitable for grassroots development, and attract people to seek medical treatment nearby. According to the needs of primary medical and health services, doctors and managers of medical institutions above the second level are arranged to serve at the primary level every year to help primary medical and health institutions improve their service level. Strictly implement the provision that city doctors should serve at the grassroots level before being promoted to deputy chief physician, establish a service system for young doctors at the grassroots level, strengthen dynamic management, increase assessment, and improve the effect of counterpart support.

Third, safeguard measures.

(1) Strengthen organizational leadership. All localities and relevant departments should incorporate the strengthening of rural doctors into the overall consideration of deepening the reform of the medical and health system, strengthen leadership, and solidly organize and promote it. Municipalities (states) should formulate specific implementation plans before the end of August and report them to the Provincial Health and Family Planning Commission, the Provincial Development and Reform Commission, the Education Department, the Finance Department and the Human Resources and Social Security Department for the record.

(2) Improve the fund guarantee mechanism. Finance at all levels should effectively assume the responsibility of funding for the construction of grassroots health talents, timely and fully allocate relevant funds, and ensure earmarking. Provincial finance should further increase subsidies to difficult areas.

(3) Strengthen supervision and guidance. Establish a supervision and notification system to ensure that all policies to strengthen the construction of rural doctors and innovate the training and use mechanism of grassroots health personnel are implemented. It is necessary to earnestly safeguard the legitimate rights and interests of grassroots medical and health personnel, and it is strictly forbidden to collect or apportion fees from rural doctors outside the provisions of the state in any name. It is necessary to vigorously publicize the advanced models and deeds of grassroots medical personnel in serving the masses and protecting health, and commend rural doctors and other grassroots medical and health workers who have made outstanding achievements in preventive health care, medical services and emergency treatment in accordance with relevant state regulations.

General Office of Sichuan Provincial People's Government

August 20 15 14