Thông tư 16/2014/TT-BYT hướng dẫn thí điểm về bác sĩ gia đình và phòng khám bác sĩ gia đình do Bộ trưởng Bộ Y tế ban hành

CIRCULAR

GUIDING THE PILOT MODEL OF FAMILY DOCTORS AND FAMILY DOCTOR CLINICS (*)

Pursuant to November 23, 2009 Law on Medical Examination and Treatment;

Pursuant to the Government’s Decree No. 87/2011/ND-CP of September 27, 2011, detailing and guiding a number of articles of the Law on Medical Examination and Treatment;

Pursuant to the Government’s Decree No. 63/2012/ND-CP, defining the functions, tasks, powers and organizational structure of the Ministry of Health;

At the proposal of the director of the Medical Examination and Treatment Department;

The Minister of Health promulgates the Circular guiding the pilot model of family doctors and family doctor clinics.

Chapter I

GENERAL PROVISIONS

Article 1. Scope of regulation and subjects of application

1. Scope of regulation;

This Circular guides:

a/ Functions, tasks and rights of family doctors; conditions, competence, procedures and dossiers of application for family doctor practice certificates and registration of family doctor practice;

b/ Organization, operation, conditions, competence, procedures and dossiers of application for operation licenses for family doctor clinics.

Issues not yet governed by this Circular must comply with the Law on Medical Examination and Treatment and guiding documents.

2. Subjects of application:

a/ This Circular will apply on a trial basis in 8 provinces and centrally run cities, namely Hanoi, Ho Chi Minh City, Hai Phong, Can Tho, Thai Nguyen, Thua Thien Hue, Khanh Hoa and Tien Giang, under Decision No. 935/QD-BYT of March 22, 2013, on approval of the scheme on establishment and development of the model of family doctor clinics in the 2013- 2020 period.

b/ In addition to the 8 provinces and centrally-run cities in which the pilot model is applied as specified at Point a, Clause 2 of this Article, if organizations and individuals in other localities wish to apply for practice certificates or operation licenses for family doctor clinics, the Health Departments of the provinces and centrally-run cities where these organizations and individuals are located shall send written requests to the Ministry of Health for guidance on the application of this Circular.

Article 2. Principles of operation of family doctors

1. Family doctors operate on the principle of continuous, comprehensive, integrated, coordinated, preventive and family- and community-based health care.

2. Family doctors form and maintain trustful and long-term relations with individuals, households and the community.

Article 3. Organizational forms of family doctor clinics

Family doctor clinics shall be organized in one of the following forms:

1. Private family doctor clinics, including:

a/ Independent private family doctor clinics;

b/ Family doctor clinics in private general medical clinics or private general hospitals.

2. Family doctor clinics of the medical examination departments of state-run general hospitals.

3. Communal health clinics having the task of family doctor clinics.

Chapter II

FUNCTIONS, TASKS, CONDITIONS AND COMPETENCE OF FAMILY DOCTORS AND PROCEDURES FOR GRANT OF FAMILY DOCTOR PRACTICE CERTIFICATES

Article 4. Functions and tasks of family doctors

1. Family doctors have the functions of medical examination and treatment, management, protection, care for and improvement of all-round health of individuals, households and the community.

2. Family doctors have the following tasks:

a/ To comprehensively and continuously manage health of individuals, households and the community;

b/ To screen for early detection of diseases;

c/ To give first aid, examination and treatment, provide functional rehabilitation to individuals, households and the community within the professional operation scope stated in their practice certificates;

d/ To provide advices on health, disease prevention, prevention and control of health risks so as to improve the capacity of individuals, households and the community in taking initiative in protecting, caring for and improving their health;

dd/ To provide information on health of individuals and households managed by family doctors in accordance with law;

e/ Other tasks within the scope of practice stated in their practice certificates.

Article 5. Rights of family doctors

1. To provide health insurance-covered medical examination and treatment when satisfying the conditions prescribed by the law on health insurance.

2. To transfer patients to medical examination and treatment establishments in compliance with regulations on transfer of medical examination and treatment levels in case of necessity under the Ministry of Health’s regulations.

3. To receive feedback from medical examination and treatment establishments that receive patients transferred by family doctor clinics.

4. To receive training and retraining to improve their professional qualifications.

Article 6. Conditions for Vietnamese to obtain a family doctor practice certificate

A Vietnamese person may be considered for grant of a family doctor practice certificate when meeting all the following conditions:

1. Condition of degree:

a/ An applicant for family doctor practice certificate before January 1, 2016, must possess at least a general doctor degree and a certificate of training or retraining in family medicine for at least 3 months granted by a training establishment accredited by the Ministry of Health or provincial-level Health Department;

b/ An applicant for family doctor practice certificate on or after January 1, 2016, must possess at least a general doctor degree and a level-1 specialized doctor, level-2 specialized doctor, family medicine master or doctor degree or a certificate of specialized training in family medicine granted or recognized in Vietnam.

2. Condition of medical examination and treatment practice period:

a/ An applicant for family doctor practice certificate before January 1, 2016, must possess a document certifying his/her period of medical examination and treatment practice of 18 months at medical examination and treatment establishments in accordance with the Law on Medical Examination and Treatment and the Minister of Health’s Circular No. 41/2011/TT-BYT of November 14, 2011, guiding the grant of practice certificates to practitioners and operation licenses for medical examination and treatment establishments;

b/ An applicant for family doctor practice certificate on or after January 1, 2016, must possess a document certifying his/her period of medical examination and treatment practice of 18 consecutive months or more at general hospitals.

The practice period of a person with a level-1 specialized doctor degree, level-2 specialized doctor degree or certificate of specialized training in family medicine shall be calculated as a training period. Certified copies of level-1 specialized doctor degrees, level-2 specialized doctor degrees or certificates of specialized training in family medicine are considered certificates of practice period. Particularly, those possessing certificates of specialized training in family medicine must also have certificates of continuous practice period of 18 months in addition to the practice period which is considered a training period.

3. Falling outside the cases specified in Clause 4, Article 18 of the Law on Medical Examination and Treatment.

Article 7. Conditions for foreigners and overseas Vietnamese to obtain family doctor practice certificates and have their family doctor practice certificates recognized

1. Foreigners and overseas Vietnamese may be considered for grant of family doctor practice certificates when fully meeting the following conditions:

a/ All the conditions prescribed in Article 6 of this Circular;

b/ Falling outside the cases prescribed in Clause 4, Article 18 of the Law on Medical Examination and Treatment;

c/ The conditions prescribed in Clauses 2, 3 and 4, Article 19 of the Law on Medical Examination and Treatment.

2. Foreigners and overseas Vietnamese that have family doctor practice certificates granted by foreign countries shall comply with Article 22 of the Law on Medical Examination and Treatment.

Article 8. Competence, dossiers and procedures for grant and re-grant of family doctor practice certificates and registration of family doctor practice

The competence, dossiers and procedures for grant and re-grant of family doctor practice certificates and registration of family doctor practice comply with the Minister of Health’s Circular No. 41/2011/TT-BYT of November 14,2011, guiding the grant of practice certificates to practitioners and operation licenses to medical examination and treatment establishments, and other relevant legal documents.

Chapter III

ORGANIZATION, OPERATION, CONDITIONS AND COMPETENCE OF FAMILY DOCTOR CLINICS, PROCEDURES FOR GRANT OF OPERATION LICENSES FOR FAMILY DOCTOR CLINICS

Article 9. Position, functions and tasks of family doctor clinics in the system of medical examination and treatment establishments

1. A family doctor clinic is one of the first establishments receiving patients in the system of medical examination and treatment establishments.

2. Family doctor clinics have the following tasks:

a/ To screen, give first aid, medical examination and treatment, transfer patients to other medical examination and treatment establishments under regulations on transfer of medical examination and treatment levels, and receive patients for further health management, protection, care and improvement;

b/ To closely coordinate with medical examination and treatment establishments in the system in ensuring health management, medical examination and treatment for individuals, households and the community;

c/ To make contacts for transfer of patients under their management to appropriate medical examination and treatment establishments for examination and treatment.

Article 10. Professional and technical levels and list of professional and technical operations of family doctor clinics

1. Independent private family doctor clinics and communal health clinics with integrated or added functions and tasks of family doctor clinics shall apply professional and technical levels and list of professional and technical operations specified in the Minister of Health’s Circular No. 43/2013/TT-BYT of December 11, 2013, detailing professional and technical levels of the system of medical examination and treatment establishments (below referred to as Circular No. 43/2013/TT-BYT).

2. Family doctor clinics in private general medical clinics or private general hospitals shall apply the professional and technical levels and list of technical operations for the level of private general medical clinics or private general hospitals specified in Circular No. 43/2013/ TT-BYT.

3. Family doctor clinics of the medical examination departments of public general hospitals shall apply the professional and technical levels and the list of technical operations for the level of public general hospitals specified in Circular No. 43/2013/TT-BYT.

Article 11. Provision of health insurance-covered medical examination and treatment by family doctor clinics

Family doctor clinics may provide health insurance-covered medical examination and treatment in accordance with the law on health insurance.

Article 12. Management of medical history records, statistics and archives of family doctor clinics

1. Family doctor clinics shall record and archive information on medical examination and treatment in accordance with the law on medical examination and treatment.

2. Family doctor clinics must have records of comprehensive management of health of individuals and households already registered for health management. These clinics shall keep confidential personal information of those registered for health management in accordance with law.

3. Family doctor clinics shall manage medical history records, statistics and archives in compliance with the law on medical examination and treatment establishments.

Article 13. Medical examination and treatment service charges of family doctor clinics

1. Medical examination and treatment service charges are as follows:

a/ Public family doctor clinics shall apply medical examination and treatment service charges approved by competent state agencies;

b/ Private family doctor clinics may decide on their service charges but shall publicly post up such service charges and collect them at posted rates in accordance with the price law.

2. Charges for health insurance-covered medical examination and treatment services must comply with the law on health insurance.

Article 14. Conditions for independent private family doctor clinics to obtain operation licenses

1. Physical foundations

a/ Construction and design:

- They are in fixed location separated from spaces for family daily-life activities;

- They are solidly built and well-lit with dust-proof ceilings and walls and floors made of easy-to-clean materials;

b/ There must be an in-patient reception, a medical examination and health consultancy room of at least 10 m2.

c/ In addition to the conditions prescribed at Points a and b of this Clause, depending on the scope of registered professional operations, a clinic must meet the conditions prescribed by the law on medical examination and treatment in conformity with its organizational form and scope of registered professional operation.

d/ Ensuring treatment of medical waste and control of bacterial contamination in accordance with law;

dd/ There must be equipment for information technology application in health management and medical examination and treatment;

e/ Ensuring sufficient electricity, water, toilets and other conditions to serve patients.

2. Medicine and medical equipment

There must be sufficient medical equipment and tools and medicines conformable with the scope of registered professional operation of clinics, including at least an anti-shock first aid kit and sufficient specialized first-aid medicines.

3. Personnel

a/ A person responsible for professional operations of a clinic must satisfy the following conditions:

- For family doctor clinics applying for operation licenses before January 1, 2018, the person responsible for professional operations of a clinic must be a doctor that has a practice certificate in family medicine and has provided medical examination and treatment for at least 36 months;

- For family doctor clinics applying for operation licenses on or after January 1, 2018, the person responsible for professional operations of a clinic must be a doctor that has a practice certificate in family medicine and has provided medical examination and treatment for at least 36 months, including full 24 months of medical examination and treatment specializing in family medicine.

b/ A person directly providing medical examination and treatment and managing health must possess a family doctor practice certificate;

c/ A person performing professional jobs of a clinic must possess a practice certificate suitable to the scope of professional operations;

d/ Apart from the conditions prescribed in this Clause, a practitioner must also possess a certificate of professional training or retraining according to professional and technical requirements.

4. Scope of professional operations

Family doctor clinics may perform the following professional operations:

a/ Medical examination and treatment:

- To give first aid and intensive care;

- To provide medical examination and treatment according to the list of technical operations approved by a competent state agency;

- To comprehensively manage health of individuals, households and the community;

- To provide health care and screening for early detection of diseases;

- To change medical examination and treatment levels;

- To provide palliative care and end-of-life care services;

- To perform other professional techniques approved by competent state agencies based on practical conditions of clinics;

- To carry out the following activities in a patient’s family: medical examination, prescription for common illnesses; performing a number of operations, such as dress changing, suture removal, collection of urine and blood samples for testing, aerosols; injection and transfusion of fluids in emergency cases.

b/ Functional rehabilitation:

- To organize the community-based functional rehabilitation for those in need;

- To perform techniques of functional rehabilitation, physical therapy and physical exercise for patients and the community,

c/ Traditional medicine:

- To provide medical examination and treatment with traditional medicine methods (with or without medications);

- To use herbal medicine ingredients produced by other establishments with circulation registration granted by the Ministry of Health to serve medical examination and treatment;

- To process raw herbs into semi-processed herbal medicines, and weigh herbal portions for patients;

d/ Disease prevention and primary healthcare:

- To take part in supervising and early detecting epidemics in the community;

- To take part in immunization programs, national health programs;

- To guide environmental sanitation, food hygiene and safety, prevention and control of infectious diseases and non-infectious diseases;

- To participate in the management of occupational diseases, maternal, child and elderly healthcare, periodic health checkup to help early detect diseases; to make medical history records to keep a comprehensive and constant watch of individual and family health under the Ministry of Health’s regulations.

dd/ Health consultancy:

- To provide people and the community with consultancy on medical examination and treatment, disease prevention, healthcare and health improvement;

- To participate in health communication and education to contribute to improving public awareness about active disease prevention, the prevention of health risks.

e/ Scientific research and training:

- To conduct scientific research into family medicine and related issues;

- To participate in specialized training in family medicine;

- To participate in constant training programs in family medicine to improve professional skills.

Article 15. Operation conditions on family doctor clinics in private general medical clinics or the medical examination departments of general hospitals

1. Family doctor clinics in private general medical clinics or medical examination departments of general hospitals must satisfy the conditions prescribed in Article 14 of this Circular.

2. Private general clinics or general hospitals having family doctor clinics shall carry out the following procedures:

a/ Private general clinics or newly-established general hospitals having family doctor clinics must be appraised and satisfy the operation conditions on family doctor clinics prescribed in Article 14 of this Circular upon the grant of operation licenses;

b/ Private general clinics or general hospitals that obtained operation licenses which add family doctor clinics must possess competent authorities’ decisions on clinic establishment and make written requests for competent state agencies having granted operation licenses to appraise and supplement the scope of professional operations in operation licenses.

Article 16. Competence, dossiers and procedures for grant of operation licenses for independent family doctor clinics

The competence, dossiers and procedures for grant of operation licenses of independent family doctor clinics established and registered for operation by family doctors must comply with the Minister of Health’s Circular No. 41/2011/TT-BYT of November 14, 2011, guiding the grant of practice certificates to practitioners and operation licenses for medical examination and treatment establishments, and other related legal documents.

Article 17. Communal health clinics with integrated or added tasks of family doctor clinics

1. Medical examination and treatment tasks in family medicine at communal health clinics shall be integrated or added as follows:

a/ In addition to the tasks under current regulations, communal health clinics may perform medical examination and treatment in family medicine;

b/ Communal health clinics may arrange a separate section or a family doctor to provide medical examination and treatment in family medicine.

2. Conditions for provision of medical examination and treatment in family medicine

If providing medical examination and treatment in family medicine, a communal health clinic must satisfy the conditions on physical foundation, equipment and personnel prescribed in Article 15 of this Circular in conformity with its scope of professional operations in family medicine.'

Chapter IV

IMPLEMENTATION RESPONSIBILITY

Article 18. Management of operation of family doctor clinics

1. The Healthcare Management Department shall act as the focal point in assisting to the Minister of Health in the state management of operation of family doctor clinics nationwide.

2. Directors of provincial-level Health Departments shall comprehensively manage family doctor clinics in their localities.

3. Health clinics of districts and towns shall examine and supervise the operation of family doctor clinics in their localities under regulations.

Article 19. Responsibilities of units of the Ministry of Health

1. The Healthcare Management Department shall:

a/ Assist the Minister of Health in guiding and organizing the establishment and development of the model of family doctor clinics;

b/ Act as the focal point and coordinate with related agencies and units in elaborating annual detail plans on the establishment and development of the model of family doctor clinics and report them to the Minister of Health for consideration and approval, and organizing approved activities under its assigned functions and tasks.

c/ To appraise application dossiers for grant of family doctor practice certificates within its competence. To guide, examine and supervise the implementation of professional regulations on the operation of family doctor clinics; and the application of information technology in clinics and the whole system;

d/ To guide provincial-level Health Departments to grant and revoke family doctor practice certificates; to appraise application dossiers, grant and revoke operation licenses for family doctor clinics in accordance with the Law on Medical Examination and Treatment and guiding legal documents;

dd/ To instruct, guide, examine and supervise the implementation of legal documents and professional regulations for family doctor clinics.

2. The Health Insurance Department shall assume the prime responsibility for, and coordinate with the Healthcare Management Department and related units in, guiding and examining the implementation of the regulations on health insurance-covered medical examination and treatment in family doctor clinics.

3. The Department of Science, Technology and Training shall assume the prime responsibility for, and coordinate with the Healthcare Management Department and related units in, guiding and organizing the elaboration and appraisal of training and constant training programs and materials for the grant of practice certificates in family medicine.

4. The Information Technology Department shall assume the prime responsibility for, and coordinate with the Healthcare Management Department in, guiding the application of information technology in operation of family doctor clinics.

5. The Planning and Finance Department shall coordinate with the Healthcare Management Department in elaborating, supplementing and guiding the implementation of regulations on medical examination and treatment service charges within the scope of family doctor clinics’ professional operations;

6. The Organization and Personnel Department shall coordinate with the Healthcare Management Department in guiding, examining and supervising the implementation of functions, tasks, regimes and policies on family doctors.

Article 20. Responsibilities of provincial-level Health Departments in localities where the pilot model is applied

1. To organize the establishment and development of the model of family doctor clinics in their localities.

2. To grant, re-grant and revoke family doctor practice certificates for practitioners; to appraise application dossiers and grant operation licenses for family doctor clinics in accordance with the law on medical examination and treatment.

3. To comprehensively manage family doctor clinics.

Chapter V

IMPLEMENTATION PROVISIONS

Article 21. Effect

1. This Circular takes effect on July 15, 2014.

2. To annul the provisions on family doctor clinics of Article 25 of the Minister of Health’s Circular No. 41/2011/TT-BYT of November 14, 2011, guiding the grant of practice certificates to practitioners and operation licenses for medical examination and treatment establishments from the effective date of this Circular.

Article 22. Transitional provisions

Those who have already obtained medical examination and treatment practice certificates and are providing medical examination and treatment in family medicine may continue to use granted certificates in such practice and need not have such certificates re-granted but shall take responsibility for constantly updating their medical knowledge to meet the criteria specified in Article 6 of this Circular.

Article 23. Reference provision

In case the relevant documents referred to in this Circular are amended, supplemented or replaced, the amending, supplementing or replacing documents must be complied with.

Article 24. Implementation responsibility

The director of the Healthcare Management Department, the chief of the Ministry’s Office, the Ministry’s Chief Inspector, directors and general directors of departments and general departments of the Health Ministry, directors of provincial-level Health Departments, heads of health sections of sectors and heads of related agencies, organizations and units shall implement this Circular.

Any problems arising in the course of implementation should be promptly reported to the Ministry of Health (the Healthcare Management Department) for consideration and settlement.-

(*) Công Báo Nos 615-616 (24/6/2014)