Bridging the GP gap: nurse practitioners in China

China's 2009 national health reform focused on health insurance, drugs, public health, hospitals, and primary care. 1 Chen Z Launch of the health-care reform plan in China. Lancet. 2009; 373: 1322-1324 Summary Full Text Full Text PDF PubMed Scopus (394) Google Scholar On its tenth anniversary, evaluations of the reforms are underway. 2 Meng Q Mills A Wang L Han Q What can we learn from China's health system reform?. BMJ. 2019; 365l2349 Crossref PubMed Scopus (150) Google Scholar There has been good progress in some areas, such as medical insurance coverage through National Healthcare Security Administration. Obstacles, however, hinder progress in other areas. Primary care and large hospitals have been the most resistant to reform efforts. The Chinese Government has set the goal of achieving 300 000 general practitioners (GPs) by 2020—or two to three GPs per 10 000 population by 2020—and a net GP workforce of 700 000, or five GPs per 10 000 population by 2030. 3 Lian SQ Chen Q Yao M Chi CH Fetters MD Training pathways to working as a general practitioner in China. Fam Med. 2019; 51: 262-270 Crossref PubMed Scopus (22) Google Scholar GP specialty training is among 36 specialties in China's national standardised residency training. 4 Zhu J Li WMD Chen LMD Doctors in China: improving quality through modernisation of residency education. Lancet. 2016; 388: 1922-1929 Summary Full Text Full Text PDF PubMed Scopus (77) Google Scholar Government policies had prioritised the GP workforce for primary health care through favourable policies and more public investments. Free scholarships have been offered for medical students who commit to serving 6 years after graduation at the township level. 5 National Health Commission of the People's Republic of ChinaImplementation opinions on the free training of rural order-oriented medical students. 2010http://www.nhc.gov.cn/qjjys/s3593/201006/ab26a8f7a5714af983be817f1a0d1f49.shtmlDate accessed: September 11, 2019 Google Scholar One study showed that only 1·6% of recipients of GP scholarships from rural areas are willing to serve at the rural township level; 80% of them reported to duty at the rural township level right after graduation. 6 Hu D Chen CK Zhang C et al. Effectiveness and challenge of targeted admission medical education program in rural China. Chinese J Health Pol. 2018; 11: 28-33 Google Scholar The reasons for not opting to practise at the township level include remote rural postings, low status, low pay, perception of dead-end jobs, and not wanting to live with their families in deprived areas with poor education for their children. 7 Li X Lu J Hu S et al. The primary health-care system in China. Lancet. 2017; 390: 2584-2594 Summary Full Text Full Text PDF PubMed Scopus (426) Google Scholar China's health-care reform: an independent evaluationWhen The Lancet visited the National Health Commission of China in 2018, Ma Xiaowei , the minister of health, said he would welcome independent assessment of the progress of China's health reforms. Today, The Lancet dedicates the ninth China-themed issue to evaluate progress of China's health-care reform since 2009, which coincides with the fifth Lancet–Chinese Academy of Medical Sciences (CAMS) Health Conference, held in Chengdu on Oct 19–20. Full-Text PDF