by Bruno Palmas
22 NOV – Dear Director,
the feared passage of family medicine to addiction has generated in the OO.SS. category, in some of the doctors, in the leaders of the ENPAM concern and bewilderment. The pandemic, highlighting the difficulties of the NHS, confirmed that citizens need local health care and family medicine almost like bread to support the care burden outside the hospital and guarantee the global care of healthy and sick people.
However, given that without the reform of family medicine any effort to change the territory will be in vain, it needs various corrections and not so much the modification of its legal status.
Family doctors’ path to addiction is wrong for various reasons.
This is in many ways an ideological position, given that the characteristics of addiction are not immediately applicable to the functions of general medicine, and are incompatible with the exercise of free fiduciary choice by the citizen. The lack of a “contract” of mutual trust creates an evident de-responsibility of doctors with respect to people.
Moreover, the status of affiliated doctors does not imply the renunciation of some typical conditions of dependence (holidays, thirteenth, paid replacements, severance pay, etc.): other affiliated doctors (outpatient specialists) already have these guarantees. If the issue is to limit the excessive autonomy of family doctors, the approach must be different.
Professional training must be reformed in a serious way, which must leave the corporate logic and self-referentiality and start a university organizational and management path (like the other specialties) but with a strong didactic contamination by those who, in the MdF and territorial had relevant and recognized scientific and clinical managerial roles and curricula.
Access to the employment relationship cannot be entrusted to rankings based solely on qualifications, but should be guaranteed through selection procedures based on qualifications and exams, in order to guarantee the NHS family doctors continuously up to the level of access selection.
The modus operandi of the MdF must be organized to guarantee the continuity of territorial assistance over 24 hours, without interruption, defining and integrating the roles of each person in the day and in the night, the distribution of the principals and territorial areas in widespread and capillary way, and not only in major urban realities.
The relationship of trust between citizen and doctor must be intangible, and reciprocal free choice is the basis of the free and aware professional / personal citizen-doctor contract. For this, a not narrow gap between maximum and optimal is necessary, wide territorial areas, widespread diffusion of medical offices, opening hours of appropriate offices in the presence, to make the citizen free to choose but not to exercise the “blackmail of revocation”.
The nature of taking charge must be global, to fully protect people’s health, without crystallization of performance, aimed at guaranteeing the necessary clinical and instrumental activities in the office, with modern technologies, as a binding basis for the agreement and for accreditation. .
Professional quality standards and appropriateness verification models should be defined. Accepting to be evaluated according to parameters of good practice, guidelines, professional protocols must be an operational and accreditation precondition, with a serious reform of the bureaucratic burden.
The social security contribution of the MdF is absolutely inadequate and very far from the standards of dependence, so much so that today family doctors have medium-low pensions.
On the remuneration, however, all forms of performance remuneration must be overcome. It is necessary to weigh the capital quota by personal status, welfare burden (chronic pathology, degenerative pathologies, etc.), geographical discomfort, and any other condition that affects the professional burden. The separation between guarantee remuneration (the one appropriate to a just personal and professional life) and that of result, consequent to the evaluation of quality and results, must be decided.
Starting over from the District. Thinking about the reorganization of local healthcare means addressing the long-standing and strategic question of the District. It now appears abandoned to itself, given that, compared to the hospital, it has suffered from the lack of attention of company managers and the chronic underestimation of facilities, instrumental and financial equipment, dedicated health personnel, and poor strategic vision.
The availability of the Recovery Found resources is the occasion for its redemption.
It will be necessary to make it visible and recognizable by citizens as a place and functional tool of the health response, like the hospital, in order to:
1. To guarantee people continuous assistance,
2. Reform and team up with local professionals.
3. Networking the territorial offices.
4. Strengthen computer networks.
5. Bringing services closer to people in the area, adopting the concept of socio-health proximity and equity as a guiding value of services.
6. Integrate the territorial health and social services with each other, and of these with the hospital functions, through the Community Houses.
If this is done, I believe that we would have given the Territory System all the opportunities to guarantee citizens the real protection of health. On both sides of the NHS, the hospital one and, in fact, the territorial one. As it should be.
Bruno Palmas
National Secretary TDMe (Court of the doctor)
22 November 2021
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