of the Italian Society of Community Medicine and Primary Care
01 DIC –
Dear Director,
during the final day of the Risk Management Forum, the results of a survey promoted by Federsanità were presented which show us a National Health Service (SSN) progressively depleted of human resources, with professionals on the run due to exhausting shifts and wages not up to height of other European countries. The NHS is no longer able to have the appeal it once had and an increasing number of health professionals choose to place their skills at the service of the private sector, which is able to offer better contractual conditions and quality of life. To attract public service and keep professionals in healthcare companies, some solutions were proposed during the event, such as the contractual revaluation and the economic adjustment of salaries.
As the Italian Society of Community Medicine and Primary Care (SIMCCP) we are firmly convinced that an advanced and cutting-edge NHS must enhance its operators both from an economic point of view but also from a professional point of view. We need a Health Service that knows how to make the most of its professionals, getting rid of useless ideological and corporatist fences that hinder the achievement of the “health value”.
The PNRR offers the great opportunity to be able to modernize the public health service and make it more attractive, but to do so it is necessary to have the courage to propose a serious structural reform not only of the hospital sector but also and above all of the territorial sector, historically neglected, through the development of Community medicine. The work in the area, due to its peculiarities and management complexities, however, cannot be improvised but requires adequate medical training which can be acquired thanks to the specialization school in Community Medicine and Primary Care. This school offers methods and tools to be able to operate in the territorial services of Primary Health Care, Organization of Basic Health Services (DIM 68/2015) and Palliative Care (DM 11 August 2020). However, only two out of three of these competition classes are currently active for specialists in Community Medicine and Primary Care, in fact the implementing decree that activates the competition class for access to Primary Health Care is still missing.
An NHS in step with the times and which takes care of the resources it forms would have already filled this regulatory gap to attract young doctors to the profession suited to the area, as has recently been adopted for Emergency Medicine.
How can you expect a young doctor entering the world of work to choose to operate in the Territory and in Primary Care if the specialists specifically trained to work there are not adequately valued?
We have experienced to our cost the total absence of a super partes body that guarantees professional protection, since the existing ones either don’t work or are steeped in profound conflicts of interest.
The reforms should be designed by listening to all professionals and to the scientific societies or cultural movements that represent them and not just to the trade unions.
Being part of an executive that makes merit a cardinal principle, we expect the Minister of Health Hon. Schillaci to remedy as soon as possible this serious regulatory vulnerability that prevents Community and Primary Care Doctors from exercising primary health care as medical directors or civil servants. The serious shortage of affiliated General Practitioners should favor this choice, because the problem is exclusively political; in fact, there are no reasons of a technical nature that prevent its application.
The new standards for the development of territorial assistance include the Community Medicine Doctor among the members of the territorial multidisciplinary team and entrust him with the performance of primary care clinical activities (Annex 1 of the Decree of 23 May 2022 n. 77). In fact, the Community Doctor is a professional specially trained to perform clinical and organizational roles within the Territorial Services and within Community Houses and Community Hospitals he could mainly deal with the management of chronic and complex patients.
In order for the territorial healthcare reform to be truly effective, it cannot be limited to the construction of new structures or the modernization of pre-existing structures. We are convinced that at the basis of a reform process there must be a profound cultural change, which sees Primary Assistance strongly integrated within the social and health Districts and which therefore cannot disregard the professional recognition of the figure of Community Doctor and Primary Care.
On behalf of SIMCCP we take the opportunity to launch our Programmatic Manifesto aimed at spreading the culture of Community Medicine and Primary Care and professionally enhancing its specialists. Below are the main requests made by SIMCCP to the competent institutions:
– Establishment of the Competition Class “Community Medicine and Primary Care” for the training of medical managers who can operate in Districts, Departments of Primary Care, Community Homes and Community Hospitals, with clinical roles in primary health care;
– Renaming of the competition class in the ACN of the Outpatient specialist from “Community Medicine” to “Community Medicine and Primary Care” for the recruitment of outpatient specialists to be employed in the Districts, Departments of Primary Care, Community Hospitals, Homes community, with primary health care clinical roles;
– Safeguarding of the current schools of specialization in Community Medicine and Primary Care through incentive measures in order to make it more attractive for learners to enroll in postgraduate courses dedicated to the territory (on a par with what happened for the school of Emergency Medicine-Urgency);
– Creation of the Scientific Disciplinary Sector (SSD) in “Community Medicine and Primary Care” to promote academic teaching and research in the field of Community Medicine, Primary Care, Primary Health Care and Territorial Services.
Board of Directors of the Italian Society of Community Medicine and Primary Care (SIMCCP)
01 December 2022
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