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The dependence of family doctors is now unavoidable

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by Nicola Preiti

24 SETDear Director,
the document of the Health Commission of the Regions is of extraordinary clarity and determination, which addresses without hypocrisy the imperative need for the transition to addiction to general medicine (PLS and outpatient specialist).

He will certainly find sensitivity and attentive ears in the Government to finally modernize territorial assistance, for the benefit of the entire NHS.

It is a pleasure to read this analysis and these decisions to those who, like me, since the definition of the Balduzzi Law, and then as a signatory of ACN 2005 and others, had seen this evolution as unavoidable. For the health system and for doctors.

Today it is so urgent that the Regions even consider the convention an obstacle to the system’s development path. It is a limit capable of compromising the substantial investment and the overall restructuring project of territorial assistance envisaged in the PNRR.

And that’s right: all the attempts to reorganize the territorial assistance in the last 20 years have broken on the dichotomy between the freelance doctors with agreements on the one hand, and the District on the other. And indeed, even the PNRR is destined to do the same if this knot is not resolved definitively and clearly.

No territorial assistance can be organized if the primary managers of the patient’s clinical management are not completely integrated in the territory and therefore in the District, which remains the essential organizational level of all assistance and services in the territory.

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The Regions propose four solutions, but in my opinion the solution is only the first: the transition to the dependence of all the contracted doctors, who become managers in the district.

Only this allows and guarantees the evolution in the required “uniform and simplified national regulatory framework with clear and binding rules”.

In my opinion, the other solutions would lead to inhomogeneous, confused and contradictory solutions, some of which have already failed, such as the accreditation models with Lombard service companies (see pandemic). It would also give rise to cat-like solutions already tested where the label changes but not the assistance. And the defeat of UTAP, AFT, UCCP, AF is there for all to see.

It is necessary to take decisively the main road of dependence that allows full integration, coordination with other professional figures, including community nurses, and the effective implementation of the provisions of the PNRR (Community Homes, Community Hospitals, Operational Centers Territorial, Telemedicine, Networks, Chronicity management, Home care, social integration).

Therefore, define the regulatory issue as soon as possible, perhaps with an ad hoc contract, to respect the times set by the Regions for the start of the new employment relationship: January 1, 2022.

There are no insurmountable problems. The costs are not far from the current ones, the relationship of trust is maintained and doubles, it becomes that of the citizen and the territory, with the areas of choice that must coincide with the district articulations.

Assistance would be more homogeneous across the territory. Taking charge of the citizen would be concrete (it is a function of the system, not of the individual professional). Doctors would free themselves from the bureaucracy and go back to being doctors, with greater rewards and a chance to make a career in the district.

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We could finally abolish the shame of the figure of the Medical Guard-Continuity of care doctor: a part of the category with the same title of General Medicine but relegated to a health ghetto (and in fact there are no more doctors willing to do this job).

And already in this way it would be easy to structure the 24-hour assistance in the Community Homes: just think that by fully using all the doctors of the Emergency Medical Service / CA, according to the title already in their possession of GPs, we would have a total of about 56,000 GPs (13,000 + 43,000 ). That is, we would have 1 doctor for every 950 citizens.

Only if we start from here, from dependence on all affiliated doctors, will the resources of the PNRR be used to the fullest and local health care will change its face.

Dr. Nicola Preiti
Already a signatory of ACN 2005 and later.
Provincial Coordinator Italy Viva Perugia

September 24, 2021
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