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[Health care assistants in German primary care - A structural analysis]
Simon Schwill1, Hans-Michael Mühlenfeld2, Patrick Mamay3
1Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland; Hausärztliche Vertragsgemeinschaft (HÄVG), Köln, Deutschland.
Background:
Healthcare assistants (HCAs) in German primary care have been established in various ways over the last 18 years (VERAH, EVA, AGnES, NäPä) to support general practitioners (GPs) and enable the professional development of medical assistants (MFAs). HCAs reduce GPs' workload and support the quality of care. The aim of this study was to analyze the current status of implementation.
Methods:
Structural data of the HÄVG Cologne, which organizes GP remuneration within GP-centered patient care (HZV) in Germany, was used to identify all HCAs (=VERAHs) as of March 2025. Items of VERAHs, GPs and practices were selected. Data were analyzed descriptively, focusing on VERAHs, GPs, and practice level.
Results:
Of N = 17,763 VERAHs in 14 federal German states, N = 14,900 were practicing in primary care. There were significant regional differences in the distribution of VERAHs (p < 0.001). Overall, 61% (N = 9,085) worked in GP practices treating HZV patients. 62% of GPs treating HZV patients (N = 8,444) were supported by at least one VERAH. GPs working with VERAHs were younger, more often male, more often part of GP teams, and more frequently members of the German Association of Family Physicians and General Practitioners (p < 0.001). 58% (N = 5,721) of GP practices that are open to HZV patients and employ at least one VERAH provided care for 78% (N = 5,722.884) of all HZV patients.
Discussion:
The existence of VERAHs is a structural indicator of effective primary care. After 18 years, 58% of the GP practices treating HZV patients have implemented structural prerequisites to reorganize workflows and care. This is crucial for the transformation of German primary care. Future studies should examine VERAHs' tasks and the scope of care delegated.
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