Family doctors, community nurses won’t sign up to government’s healthcare deal

Are notes and coins on the way out?

Family doctors and community care organisations say they will not sign a agreement drawn up by the health ministry which, leaks suggest, aims in part to scrap care services which do not meet quality standards or are ineffective.

The agreement, known as the Integraal Zorg Akkoord (IZA) or integral care accord, is due to be published next week as part of the government’s 2023 budget plans and experts widely expect it will include reductions in elderly care services.

Now Actiz, the umbrella group for community nursing services, says it will not sign up to the deal without more guarantees from health insurance companies.

‘ActiZ members feel the responsibility to tackle the major challenges facing healthcare … and to make district nursing future-proof,’ chairwoman Anneke Westerlaken said.

Nevertheless, with an aging population, staff shortages and mounting demand ‘there are waiting lists, deferred care and it is difficult to find care and support,’ she said. ‘Future-oriented investment in district nursing is therefore an absolute necessity. Actiz members want to see this reflected in contracts with health insurers for the coming year.’

Doctors’ organisation LHV has also said it will not sign the agreement, even though the plans may help to remove problems facing family doctor services. ‘There is, unfortunately, not enough confidence that health insurers and the health service council NZA will abide by the agreements,’ the lobby group said.

In particular, family doctors want health insurers to commit to funding longer appointment with patients in both 2023 and 2024 and more guarantees on evening and weekend rates.

Nursing organisations and mental health organisations have, however, agreed to sign up to the deal.


The aim of the IZA, which has been leaked to the media in various draft versions, is to put more focus on prevention and efficiency, while keeping healthcare affordable.

It is likely to include measures to concentrate complex care at fewer locations and make it more difficult for people to use care services which do not have a contract with a health insurance company.

Care which is labour intensive, expensive and which has a major impact on the environment, may also be subject to extra checks, Dutch media have reported.

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