di Campagna PHC 2018 Now or Never
20 OTT – Dear Director,
the debate on the necessary reforms of the NHS and Primary Care, made evident by the SARS-CoV-2 epidemic, got underway involving the operators of the sector with a daily production of statements and positions taken by organizations, public bodies and individual professionals .
Aware of the need to modernize the NHS so that it can withstand the challenges of the new globalized epidemiological scenario, having acknowledged the lack of health planning capable of addressing the structural nodes of the system and insufficient investments in health, such as the PHC 2018 Now or Never campaign we have decided to participate in the public debate through a broad and articulated reflection.
For this reason, through a participatory, interdisciplinary and interprofessional process, we have developed a proposal for the reform of Primary Care entitled “Blue Book” (in analogy with the Portuguese Primary Care reform process of 2005), whose main characteristics are a positioning ethical, political and technical, a long-term vision, tracing principles, models, strategies and tools starting from scientific literature, from international and national experiences (both of associations and individual operators).
The last point of the Blue Book concerns the contractual forms of Primary Care workers (including those of General Practitioners but not exclusively). The positioning on the form of contractualization that should concern all health operators was deliberately formulated last because we want to emphasize that in order to discuss the contracts, first of all it is necessary to have a clear idea of the overall reform of the NHS to be implemented and only then rethink the contractual forms that they must respect and realize its values. For this reason they must be previously and carefully explained.
Paradoxically, however, the current public debate is permeated by a conceptual and argumentative fallacy that reverses the order of factors by presenting the theme of the contract of a single professional subcategory of the NHS as a fundamental and necessary condition for affirming the right to health in Italy. In reality, the premise from which to start is another: the necessary revision of health and care systems from which “the contract issue” inevitably follows for all operators, not just GPs.
Our primary care reform proposal supports:
1. Health, in its broad meaning of ONE HEALTH is a Fundamental Human Right, identifying precisely in the reform of Primary Care in a perspective of Primary Health Care (PHC) the cornerstone for guaranteeing health and prosperity to all citizens. We defend the public, universal and equitable National Health Service, therefore we are against the subtle privatization and the outsourcing of services even more in light of the dramatic pandemic experience and the insufficient response of many Italian regions;
2. We support an NHS adequately funded and supplied with the human, professional and material resources necessary to guarantee the health of the community;
3. The survival of the NHS is threatened by the outsourcing of work in health, by the maintenance of forms of purchase of health services that hinder a comprehensive and lasting care of citizens, therefore they must be rejected;
4. The contraction of workers’ rights and insecurity represent a proven negative determinant for health. We are for the protection of workers’ rights, everyone, including those of the NHS. We are against the use of tools of insecurity and outsourcing of work as strategies to contain health costs and perpetuate the underfunding of the NHS;
5. The contract should be a tool to guarantee operators to be in the best possible conditions to express their human and professional specificities to the maximum, to harmoniously combine private and professional life with the aim of guaranteeing the best assistance to the population.
6. The contract is not a planning and management tool for the NHS. Some elements of the current public debate appear misleading in which the bargaining of professional forms of work is clumsily associated with the enforceability of the population’s right to health. It is not the contractual form that safeguards the right to health, but the safeguarding of workers’ rights and the defense of the public National Health System as guarantor of the Universal Human Right to Health.
7. We ask for a return to contractual forms of public dependence for the core functions of the NHS such as those relating to Primary Health Care. The return to contractual forms of public dependence must guarantee acquired social security rights.
8. The development of new contractual forms of public dependence in the NHS is an urgent and imperative issue, these forms must be in step with the times and suitable for the context to ensure:
to. equal treatment and horizontality between different professions and the importance of team and network work, and the development of a relationship of trust for all NHS professionals, structurally contrasting “medicocentrism”;
b. career progressions that are clear and appropriate to the professionalism required by the new configuration of services;
c. a variability of the contractual forms of public dependence aimed at guaranteeing flexibility in the organizational forms of the NHS in order to make it materially possible to structure the services in accordance with the needs of the communities and the characteristics of each territory. The general purpose is the guarantee of uniformity of the quality of services with a view to justice and equity throughout the national territory.
9. The Blue Book extensively addresses the crucial issues for the reform of the NHS from a Comprehensive – PHC perspective, thus placing the contractual question in a wider context of meanings in which Health is always at the center.
Offering all citizens health care and prevention systems also means taking care of the health of the operators who perform one of the essential “services” for the community. Providing adequate contractual forms generates health in operators and this certainly represents a wealth for the entire health system and citizens.
Almost all the objections and concerns raised by the public dependency contract for NHS workers are contained in the remaining points of the Blue Book, it is the campaign’s commitment to use the stimuli coming from the debate on the contract to deepen and improve the proposals contained therein, reaffirming the our desire for confrontation and constructive dialogue with all institutions, organizations and individual citizens who care about the protection of the NHS.
Campagna PHC 2018 Now or Never
October 20, 2021
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