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[The Delegation Agreement and its Implementation Inside and Outside the GP Office from the Perspective of Practice Owners].

BACKGROUND
In many regions in Germany, demographic changes are affecting general practitioners (GPs). The 2017 "Delegation Agreement" (D-A) rolled out the 2015 reform and was introduced initially only for regions with GP shortages, allowing delegation to non-medical practice personnel for all regions in Germany.


OBJECTIVES
This article explores GPs' knowledge regarding current regulations and the task-based delegation inside and outside their office.


MATERIALS AND METHODS
We conducted a quantitative anonymous postal questionnaire survey of a randomized sample of 30% of GPs working in Nord Rhine-Westphalia. The response rate was 32%. Outcomes included attitude towards delegation, self-perceived level of information about the D-A and task-based attitude towards delegation (is being delegated/is not delegable) for 34 medical tasks.


RESULTS
Over two-thirds of GPs had a positive attitude towards delegation, but only 24% reported having a good/very good level of Information regarding the D-A. "Diagnostic tasks" were most frequently delegated. Agreement on what can be delegated in the areas of "general tasks" and "counselling/education" showed significant differences based on level of information. Both well-informed and poorly informed GPs delegated in equal measure "therapeutic tasks". Two distinct groups of "diagnostic tasks" were distinguished based on GPs' information level.


CONCLUSIONS
The list of tasks being currently delegated to PAs in the fields of "diagnostics", "organization/administration" and "general tasks" shows further potential for expansion. This could be supported by improved information communicated to GPs about the health policy reform introduced by the D-A.