Resolution: Improve the framework conditions for emergency services
26.10.2023 16:26
Die Kassenärztliche Vereinigung Baden-Württemberg (KVBW) hat nach dem Urteil des Bundessozialgerichts (BSG) vom 24. Oktober auf die gravierenden Auswirkungen für den ärztlichen Bereitschaftsdienst und die Versorgung im Land hingewiesen. Die KVBW hatte am gleichen Tag eine „Notbremse“ in Gang gesetzt, die Einschränkungen in den Notfallpraxen zum Inhalt hat. Einige Notfallpraxen werden ab sofort vorübergehend ganz oder teilweise geschlossen, in nahezu allen Notfallpraxen werden die Öffnungszeiten eingeschränkt.
Established supply structure at risk
CEO Dr. Karsten Braun said: “We extremely regret this development, the consequences of which we cannot yet predict for supply. The organization of the emergency service is important for care, especially in rural areas. Baden-Württemberg in particular has shown how emergency services can be designed sensibly. Since yesterday we can no longer continue a structure that has been established for years and was essential to fulfilling our security mandate.”
His board colleague Dr. Doris Reinhardt added: “We currently have over 1,000 unoccupied doctor's seats in Baden-Württemberg, of which over 900 are for general practitioners. We now fear that our supply problems will become even greater. We expect that doctors will retire earlier than planned, and more and more will prefer to work as an employee, as this means there is no obligation to take part in on-call duty." She pointed out that the duty of service lies with the employing doctor and so that his burden becomes even greater because he then has to organize the services in addition to his own. “If the aim is actually to make self-employed, established work more attractive, there is now a threat of exactly the opposite.”
Braun made it clear that doctors who are on call all night cannot work in their practices during the day, which is why regular daily care will be severely affected by the duty of the contracted doctors. But it's not just doctors working on outpatients who will be affected, hospitals and emergency services will also be affected.
New concept for on-call service required
The meeting of representatives commissioned the KVBW in a special meeting on October 24th to develop a new concept for on-call service. For Braun there is no question: “How the on-call service and care will be designed in the future also depends largely on politics. It sets the legal framework within which we and everyone else involved can operate even when on call.” Dr. Reinhardt also urgently appealed to the responsibility of politicians to improve the framework conditions in the on-call service so that outpatient care for the population in our country is also guaranteed in emergency services. “That means quickly offering a solution that continues to provide representation opportunities with little bureaucracy and economically.” Both warned urgently: “If this doesn’t change, the effects will be even more serious than those that are now occurring as part of our “emergency brake”. are felt. In the long term, our contracted doctors will not be able to maintain the current number of emergency practices with their current opening times and the additional transport services given the already precarious supply situation.
To the background
The Federal Social Court (BSG) decided yesterday that a dentist who works as a so-called “pool doctor” in the emergency service of the Baden-Württemberg Association of Statutory Health Insurance Dentists is subject to compulsory social insurance due to this employment. Since the KVBW's on-call service has significant similarities in its organizational structure to the KZVBW's dental on-call service, the BSG's decision can also be transferred to the KVBW's on-call service.
According to the BSG press release, simply participating in the contracted dental emergency service does not automatically lead to acceptance of self-employment. Because of his integration into the processes organized by the Association of Statutory Health Insurance Dentists, the plaintiff dentist was employed as a dependent. He had no decisive, certainly no entrepreneurial influence on the organizational processes. He found a structure organized by a third party in which he fit in under the influence of others. Free and self-responsible dental work alone does not justify exemption from social security obligations.