by Roberto Zanini
22 FEB – Dear Director,
the PNRR intervenes on territorial services: Community House, Community Hospitals, Territorial Operational Centers and telemedicine In this regard, in this letter addressed to the trade unions who sit at the company tables, I propose to think about the different reasons that support the opportunity or not to include the figure of the general practitioner in the staff of the NHS.
The union is opposed to having general practitioners join the NHS staff essentially for five reasons:
1. the relationship of trust between doctor and patient would fail to be replaced with an anonymous and impersonal form of healthcare;
2. Enpam, the social security institution for white coats, would default;
3. State health care expenditure would rise to such an extent that the request for transformation of the general practitioner into an NHS staff is already unrealistic;
4. the organizational flexibility typical of the free profession would be undermined;
5. the foreseeable contractual and legal rigidities would be imposed on the freelancer on issues such as holidays, leave, absences, replacements and more.
These, in short, are the main reasons put forward by the union, which, however, seem to escape various critical issues that the general practitioner usually has to deal with in his daily working life, here are some of them:
1. I would start first of all by debunking the myth of the flexibility enjoyed by the free profession against the so-called “contractual rigidities”. The current shortage of doctors now prevents the general practitioner from being absent in case of illness (the doctor who works even if sick has become a “classic”), ensures only very short holidays (so as not to overload colleagues) and, even more serious, it does not even guarantee a peaceful maternity leave.
Yet, illness, accident, holidays, leave belong to that set of essential rights, about which very probably one should not even see the need to discuss …
2. Still with regard to the profession, I stress that its flexibility has been transformed into a sort of container for which the general practitioner is asked to do a little bit of everything, perhaps by offering him a not particularly generous incentive policy or, in the most complex situations, making a rather simplistic appeal to deontology. Our organizational flexibility, in the emergency waves, has imposed on us hours and hours of extra work that are not recognized either economically or medically, and brought so much confusion, disorientation in operations, multiplication of official and unofficial and do-it-yourself protocols. We feel the need for clear directions and workable work plans to ensure health safety and greater productivity.
3. Let us now turn to the question of social security: unfortunately the Enpam guarantees an honorable pension only upon reaching the age of sixty-eight and without TFR. We are among the least paid in Europe and probably with the lowest pensions.
4. As for the chapter “state expenses”, the union demonstrates that it has a sense of the state by not abdicating its function, but by listening again, worrying about the real problems of the category and the substantial expenses that the doctor has to face, expenses that turn out to be sufficient only to maintain a low level of assistance both in the team and in its individual exercise.
5. Doctor-patient relationship of trust: this is certainly a value that has gratified me for thirty years and continues to this day, but which unfortunately risks disappearing due to all the difficulties and inconveniences I have just described. Today, even before the relationship of trust, the citizen asks to have a doctor to treat him and to go home when needed.
We are faced with an alternative: to join the staff of the NHS or trade union cooperatives or joint-stock companies? Will the irresponsibly divided trade unions have the money to organize the necessary administrative, nursing and technological apparatus? Competing with corporations? create conditions of mutual trust between doctors themselves? We are not managers and therefore we are unable to cope with the complexity of economic and non-economic needs?
Who would like private healthcare aimed at profit?
Having said this, however, I am not sure now that a transition to dependence can be a better solution, especially since the NHS has become corporatized with little decision-making power from the medical side and with the prevalence of an economic logic.
So, given the complexity of the transformation of the current model, I think that trade unions should look for, among the many existing regional or European models of territorial assistance, someone to discuss and who also guarantees professional satisfaction which is a guarantee of productivity.
Roberto Zanini
General practitioner, Curtatone (MN)
February 22, 2022
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