Exploration and practice of general practitioner responsibility system in an urban community of Shanghai

Objective The Minhang district of Shanghai was selected as the subject and its public health management model was investigated. Methods Minhang became a pilot location for the implementation of the general practitioner responsibility system (GPRS) in 2011. Since then, the management model of public health services in the district has gradually merged with the GPRS through a series of actions: the adjustment of organizations and the coordination mechanism in community public health services, the integration of basic public health services and clinic practice, the establishment of an informationized Internet service platform, comprehensive budgeting management of public health service programs, and performance assessment management of health workers. Results By the end of 2014, the number of residents who had a contractual relationship with a general practitioner (GP) in Minhang had reached 1.4367 million and all of them had family health records. Compared with 2010, both the rate of maternal management and the rate of children management stayed at high level (≥96%), the rate of hypertension management increased (40.73% vs. 28.70%), the rate of blood pressure control increased (82.13% vs. 77.51%), the incidence of diabetes decreased (21.93% vs. 37.85%), the rate of effective control of blood glucose for diabetic patients increased (82.43% vs. 62.77%), and the rate of child health management increased (99.79% vs. 91.54%). Conclusion The GPRS has helped to create a better community health environment. However, the development of this system is limited by several factors, including the following: the shortage of GPs, most GPs do not have good public health service skills and a correct public health concept, unclear division of different services, and imperfect department coordination.