by Luciano Fassari
Furthermore, the studios must be networked and associations between professionals will be encouraged according to the AFT model. L’the opening of the studio is set at 5 days a week in the 8-20 time slot, with two morning and two afternoon slots. The studio should preferably be open from Monday to Friday and obligatorily on Monday. And the internships of young mmg must also be carried out in the houses of the community with additional remuneration compared to the scholarships. THE DOCUMENT
DEC 31 – Employment relationship always with an agreement but with an hourly commitment set at 38 hours per week, of which 20 hours to be carried out in studies and 18 hours in health care activities promoted by the district, of which at least 6 in the Community Houses. All this always without affecting the fiduciary relationship with patients. News also for the salary: 70% will be on a capital basis while 30% will be linked to certain objectives defined by the District. Furthermore, the studios must be networked and associations between professionals will be encouraged according to the AFT model.
These are some of the cornerstones of the proposal for the future of the family doctor drawn up by the Regions and the Ministry of Health that was presented to the trade unions.
The document, which Health Newspaper is able to publish, essentially represents the draft of the guideline for the drafting of the new convention of general medicine. The path is therefore still long, also because the ‘old’ 2016-2018 agreement must first be signed between the parties, which rumors predict could take place shortly if a general agreement is reached on the new act.
But in any case, the document presents many new features. In essence, at first reading it draws a madian line between the regional desires of greater control over mmg (and also the strength of pediatricians) but without reaching a real form of addiction.
This is specifically what the draft provides, which will in any case be the subject of comparison and on which the trade unions will certainly present their counter-proposals.
Let’s start with the contract.General practitioners will continue to have a full-time working relationship with the NHS, upon the patient’s fiduciary choice.
Commitment of 38 hours of work per week.
The total hourly commitment is 38 hours per week divided as follows:
– from a minimum of 5 hours to a maximum of 20 for assistance activities carried out in the offices of GPs or AFT in a trusting relationship with their clients;
– 18 hours for activities promoted by the district, of which at least 6 in the community house, for projects promoted by the district;
Non-maximal GPs, that is, with less than 1,000 clients, complete the hourly commitment by carrying out activities organized and promoted by the district in addition to the 18 hours previously mentioned;
Opening of studies
Each MMG insures l’opening of the studio 5 days a week from 8.00 to 20.00, with two morning and two afternoon slots. The studio must preferably be open from Monday to Friday and obligatorily on Monday.
The GP for outpatient visits carries out, in relation to the epidemiological context, up to 20 hours per week (for the maximalist doctor) and must guarantee, in any case, a presence of not less than:
5 hours up to 500 assisted; 10 hours between 500 and 1,000 assisted; 15 hours between 1,000 and 1,500 people assisted
The Community Houses
The GPs are an integral part and protagonists of the activities of the “community house”, in all its articulations, which represents:
The physical place of coordination and implementation of the care of people with greater assistance intensity and of the promotion of medicine d’initiative, starting from the “health needs” defined on the basis of the “stratification “and of the “predictive systems “. The “house” that promotes and realizes i “health projects “with particular reference to chronicity and fragility both in terms of assistance and primary and secondary prevention;
l’Reference HUB of interdisciplinary work between: general practitioners, pediatricians of free choice, affiliated specialist doctors, and other figures present such as employed doctors, community nurses and other health professionals and’social and health integration;
Organisational model.
All the activities of the GPs will be carried out within the AFT (functional territorial aggregations) in order to:
– take group work between GPs as a basic organizational standard throughout the national territory;
– ensure a’organizational interface to the community house more “large and structured “of the individual GP;
– link 30% of the new salary to the activities carried out by the AFT and to the achievement of the objectives set by the projects.
The AFTs connected to the home of the community of reference are, as a rule, 2.
The AFT have a coordinator and can take, communicating it to the District, one of the legal forms provided for by the current legislation for the’exercise of professional activities.
Rete Hub e Spoke
The studies of the GPs and the reference offices of the AFT, all’within the new network of territorial services, they will constitute the SPOKE of the HUB community houses. The network represented by the GPs’ studies constitutes a fundamental proximity defense, particularly in small municipalities, inland and mountain areas, in small islands and in urban suburbs. The functional relationship with the’Reference HUB ensures coordinated work and overcoming any form of separation or disconnection with the district.
Spoke in inland and mountain areas and small islands
In these areas where, due to the geographic and morphological characteristics of the territory, the community house is particularly distant, the GP’s study must be further strengthened (first diagnostic tools, network and telemedicine) in order to guarantee a’adequate local assistance and not to increase territorial inequalities
Governance in the District
It is the district, in a stable relationship with GPs and other health professionals, that ensures the governance of the “new territorial network ”which we create with funding from the PNRR, the first Pon salute and the funds provided for by the new budget law. A strong strengthening of the district is essential to make a leap in quality of this fundamental structure of the NHS possible.
To this end, with the funds provided for in the PNRR, specific training (of the highest quality) will be carried out for professionals, employed doctors and contracted doctors who will have to perform the function of district head and coordinators of all health areas involved, employees and affiliated. GPs work on the basis of a’common and shared agenda, on a multidisciplinary and group basis, with the other health professions and social operators, in accordance with the planning and organizational models defined by the district, in line with national and regional guidelines.
Network connection
L’IT infrastructure, defined by the district, represents the necessary prerequisite for the creation of the network of local services and the assessment of needs, activities and results. To this end it is essential to proceed to a stronger integration of the management systems of GPs with the regional and national network.
Internship GP in training
During the three years of training, the young GPs carry out part of their internship at’interior of the community house. This activity is remunerated in addition to the scholarship.
The new remuneration
The remuneration system is capital-based and is divided into:
– in a fixed quota of 70% which includes: hours set aside for outpatient activities (maximum 20); the 6 hours of activities carried out within the community house. For non-maximal doctors, the “remaining” hours required to complete the fiduciary cycle (20 hours) for the activities promoted by the district. Non-maximalist doctors, who are required to provide “residual” hours, are in any case recognized a quota equivalent to that of maximalists;
– a variable of 30% upon completion of the 38 hours (12 hours per week) to achieve the health goals defined by the district which includes:
– the hours of activities promoted by the district also at the community house (on the basis of national, regional and district plans) for: health projects, PDTA, PAI, prevention campaigns, vaccinations, home assistance, telemedicine, study activities and Research;
– participation through AFT and the achievement of the pre-set objectives is a necessary condition for accessing this portion of the remuneration.
Luciano Fassari
December 31, 2021
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