Green light from the sector Committee to the document containing the indications for Sisac for the start of negotiations for the renewal of the 2019-2021 Acn for GPs and pediatricians of free choice. In reality, there are few innovations at the regulatory level where the aim will be to improve the management of chronic patients, participation in vaccination campaigns and the relationship with the hospital for the management of acute cases. Increases of 3.78%. THE TEXT OF THE ADDRESS ACT
31 GEN –
After the threat of unrest and strike by the Fimmg, the Act of address for the renewal of the agreement of family doctors and pediatricians 2019-2021 is released. The Minister of Health had also reassured the speed of the new Act, Horace Schillaci in a meeting with union leaders. Now the Regions-Health Sector Committee has released the document that is being examined by Palazzo Chigi. After the go-ahead from the Government, at that point Sisac will be able to convene the unions and start negotiations.
But let’s see what the Act provides. In reality, there will most likely not be many innovations also because the previous Acn 2016-2018 had already “implemented the reorganization of general medicine and free-choice pediatrics” also through “the implementation of the welfare model defined by the law which provides for of all the personnel affiliated to the single-professional (AFT) and multi-professional (UCCP) organizational forms, variously renamed on the national territory, which will allow the aggregate activity at various levels of doctors, paediatricians and specialists, to guarantee the taking charge of the assisted and the continuous response to health needs”.
An arrangement that according to the Act already brings the agreement in line with Ministerial Decree 77/22. In short, pending a regulatory reform of general medicine (if it ever arrives) nothing changes for the role of family doctors and paediatricians.
At this point in the negotiations, Sisac with the trade unions will have to “arrange on the concrete declination of the negotiating clause of the previous three-year period concerning the “priority objectives of national health policy” with a decisive impact on the taking charge of the patient with chronic pathology and on the participation to the vaccination process also in pandemic contexts, also enhancing models in relation to hospital assistance for the management of acute cases”.
Specifically, “the AFTs of general medicine and pediatrics of free choice, whether or not physically operating in community homes, will have to guarantee the taking charge of the chronic patient and patients at risk of chronicity, in the first case to guarantee the most adequate treatment aimed at avoiding cases of exacerbation and recourse to hospital assistance, in the second case aimed at preventing the pathologies from evolving towards chronicity”
The UCCP, on the other hand, “provides through the multidisciplinary team, specialist and/or diagnostic services which are planned and organized by the Company also by activating the AFTs of general medicine, free-choice pediatrics, specialist outpatient clinics and with health and social-health personnel”.
Staff shortage
In the development of this care model, the AFT and the UCCP “will need the supply of personnel with priority for the organizational forms operating in the Community Houses or of doctors operating in dispersed or disadvantaged areas, and of diagnostic tools assigned pursuant to the Ministerial Decree of 29 July 2022 ”.
Community Houses
In these structures the general practitioners, together with the paediatricians of their own choice, the outpatient specialists and the medical, health and administrative employees, operate on a stable basis, or mainly, partially or in conjunction. All the doctors in the single role of primary care and the pediatricians belonging to the AFT guarantee assistance to all patients from 8.00 to 20.00, seven days a week, with an articulated alternation of the opening of the studies or at the reference office of AFT. From 20.00 to 24.00 the Company guarantees assistance to all citizens with doctors in the single role of primary care with hourly activity at the headquarters of the Community House or other headquarters, or by allowing reference office of AFT.
The night activity.
The doctors in the single role of primary care with hourly activity also provide advanced night care (24.00-8.00) according to the organizational model determined by regional programming with the adoption of the Single Headquarters or the Single European Number 116117 or in any case with an organization that allows a reduced physical presence of doctors. From this point of view, the ACN of general practice will be able to determine a decisive evolution of the single role of primary care doctors, providing indications for the definitive implementation of the same since the assignment of the tasks entrusted from the entry into force of the negotiating text.
Hourly doctors.
Publication for the single role of primary care must definitely take place with the assignment, within the limit of the coverage of the available hours, of a full-time hourly job (38 hours) and with the obligation of simultaneous opening of the studio to carry out temporary activities choice cycle. Carrying out the two activities of the assignment (hourly/choice cycle) entails the introduction of a dynamic mechanism for reconciling the hours with respect to the care workload, as part of the full-time weekly commitment. In order to cover the positions available, within the limit of the hourly/choices ceiling already defined by the current ACN (38 hours) and with the adoption of the same dynamic mechanism mentioned, the doctors already in charge of primary care for the cycle of choice at the entry into force of the ‘ACN will be able to complete the weekly commitment with hourly reporting activities and hourly reporting doctors (24 hours) will be able to complete the assignment up to 38 hours with simultaneous registration in the selection list and opening of the medical office within the AFT of belonging.
Pediatricians and the ceiling of patients. As far as free-choice paediatrics is concerned, in order to make the identification of the deficient areas more consistent with the number of assisted patients present in the area itself, the ACN will have to review the system for calculating the optimal ratio taking into account the assistables 0-14 reduced number of patients 7-14 already in charge of doctors in the sole role of primary care. At the same time, for the same sector, in confirmation of what is defined in the current NCA, the bargaining will result in a ceiling equal to 1000 assisted which includes indifferently all choices, ordinary and by way of derogation. In cases of lack of the aforementioned structures, or due to the impossibility of organizing territorial assistance at the same, these guidelines are declined for doctors and paediatricians, however included in the organizational structure defined by the region (AFT and UCCP ), adopting computerized procedures and identifying the specialist network and proximity diagnostics. In such cases, identified by the Company and/or by the Region, the commitment of regional availability for personnel and diagnostic tools is also reported individually.
The deficient areas. Given the difficulty of covering the deficient areas, the Regions can encourage acceptance of the assignment by also encouraging the availability of the doctor and pediatrician to provide continuity of care or by facilitating the opening of the practice.
3.78% increase. The national economic resources identified by current legislation and referring to the economic three-year period 2019-2021 are entrusted to bargaining as shown in the following table.
30% of these are aimed at adjusting the capita share directly assigned by the ACN and 70% at the variable share governed by the AAIIRR.
Regional Supplementary Agreements. The latter, pending the AIR, is assigned in the manner indicated by an annex to the ACN which will qualify it by referring exclusively to assistance to chronic patients, indicating the functions and duties of doctors and paediatricians, the objectives assigned to them and evaluation criteria. Subsequent signing of the RIA fully replaces the operation of the attachment. For the performance of the hourly activities within the Community Houses, the resources referred to by the staff under agreement are also allocated to general practitioners, as per art. 1, paragraph 274 of Law 30 December 2021, n. 234. The remuneration of the single-cycle doctor is also integrated with the resources referred to in art. 1, paragraphs 526 and following of Law 30 December 2018, n. 145, according to the distribution of the same defined in the State-Regions Conference.
January 31, 2023
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