Commercial general practice chains in the Netherlands

BACKGROUND: Traditionally, Dutch GPs are self-employed professionals who run a general practice either alone or in cooperation with other GPs. This traditional governance model of general practices has recently been supplemented with new models that involve private investors and general practice chains, with different ownership conditions, different relationships with health workers, and different earnings models. METHODS: We conducted a review of academic and grey literature and of media reports. We also analysed the dataset on general practitioners and general practices held by the Netherlands Institute for Health Services Research (Nivel) where we are based. RESULTS: The number of practices that are part of a commercial provider is highly uncertain. Our analysis of the Nivel dataset on general practitioners and general practices found 120 practices that were staffed with locums only. These could potentially be part of for-profit chains. However, it is likely that this also includes different forms of not-for-profit cooperations between GPs. Moreover, we found 108 practices which employed practice holders as salaried employees and were not registered as (non-profit) foundations. We estimate that the number of commercially run practices in the Netherlands is somewhere between 45 and 230 practices (out of the 4,874 practices registered in 2022). No research has so far been undertaken in the Netherlands on the consequences of the emergence of practice chains for service provision, but both positive and negative consequences are possible. The risks of decreased accessibility and continuity of care have resulted in ongoing investigations by the Inspectorate for Health Care and Youth and the Dutch Health Care Authority. CONCLUSIONS: Several general practice chains have emerged in the Netherlands and some of these are commercial, but precise data on numbers are not available. Concerns have been raised on the impact of this development on service provision.