Dutch general practitioners (GPs) are participating in a rolling strike over rates they say fail to cover the growing cost of running practices, even as new figures from the Dutch Healthcare Institute show general practice is among the fastest-growing areas of healthcare spending this year.

Spending covered by the Health Insurance Act (Zvw) is projected to increase by 6.1% to €65.6 billion. Costs under the Long-Term Care Act for elderly and special care, known as the WLZ, are also expected to rise by 5% to €40.8 billion.

These figures are based on claims submitted by health insurers and regional care offices for the first quarter of 2026 and could still be revised. Currently, they show GP care is growing almost two percentage points faster than overall Zvw spending. The institute linked the increase largely to higher regulated tariffs and pay adjustments across primary care.

Salaried GPs received a structural 3% pay increase from February while a 2.97% increase in the minimum hourly wage for medical assistants took effect in July.

“The higher GP rates in 2026 are mainly the result of a correction to rates that were previously set too low, in particular the reimbursement for practice premises,” a spokesperson for the National Association of General Practitioners (LHV) told Euractiv.

“A court had annulled the previous rates and ordered the Dutch Healthcare Authority (NZa) to reassess them. Independent research by TNO showed that the costs of suitable practice premises were not sufficiently covered,” they said.

Practices facing rising business costs

GPs say practice costs are rising as they face higher spending on staff, IT and increasingly complex care, while patient numbers and practice sizes are also growing.

“In that context, a rise of more than 20% over five years does not automatically mean that practices are comfortably funded,” the LHV spokesperson said.

“Most Dutch GPs are independent practice owners. They are not only doctors, but also employers and business owners,” they added. “That is why the LHV looks not only at the average financial position of the sector, but at whether rates are cost-covering for a future-proof GP practice.”

Paramedical care is also growing faster than average, although the healthcare institute said it does not yet have enough data to establish why.

Physiotherapy spending is expected to rise by 8.5% to €861.3 million, while expenditure on dietary advice is expected to increase by 9.8% to €75 million. Spending on combined lifestyle interventions, which aim to help people improve their diet, exercise and other habits, is projected to jump by 22.5% to €78.2 million.

Patient transport costs are also expected to rise by 8.7%, driven mainly by ambulance and helicopter services. A 5% tariff increase for regional ambulance providers reflects higher wage costs and more expensive vehicle fleets, while the remaining growth is believed to come from increased use.

Rolling strikes across the Netherlands

Currently, GPs across the Netherlands are taking turns to keep their practice doors closed for one day, although not all are participating. The LHV said it is not the organiser of the latest strikes.

“They are actions by individual GPs who have joined together in a rolling protest. The LHV is taking a different route: legal action against the rates and continued work towards a new funding model,” the LHV’s spokesperson said.

However, the strike concerns the same underlying problem. Many GPs believe that the conditions under which they have to work no longer match what patients, the government, and insurers ask of them.

“Additional money is mainly needed to keep general practice sustainable and future-proof,” the LHV spokesperson said. “If that succeeds, patients will ultimately notice it through better accessibility, more stability and GP care close to home.”

[VA]