Community centres with at least one GP, but for a maximum of six hours a week

A new step towards filling the more than 1,000 community homes funded with 2 billion from the NRRP, which are due to open by 30 June. Following the sensational halt to the reform on which the Minister of Health Orazio Schillaci had been working, the regions have just approved the policy document for the renewal of family doctors’ contracts, which, in effect, aims to break the deadlock ahead of the end-of-month deadline for the opening of these large-scale clinics, where members of the public will be able to access consultations, tests and preventive care. The policy document, explains the Conference of Regions, stipulates that in every community centre there must be “a minimum presence of at least one doctor in each community centre” and that general practitioners are obliged to work in these facilities for up to a maximum of 6 hours per week, for 48 weeks per year.

This is an important agreement, even if it appears to be a watered-down version of the reform that was ultimately shelved. In community care homes, residents should in fact have access to far more than one doctor, whereas the policy document refers to a ‘minimum presence’ of at least one doctor; moreover, there is a risk that the six hours will be a maximum target that very few doctors will actually meet – namely those who do not have too many patients, a group that is steadily shrinking, given that most GPs are close to or have exceeded the ceiling of 1,500 patients each. It remains to be seen how these issues – which are by no means minor – will be addressed in the agreement. In short, the risk is that, in the end, a small patch will be applied that is insufficient to plug the gap in healthcare staff that is actually needed. In any case, the push to finalise the agreement has involved all the key players: the sectoral trade unions (Fimmg, Smi and Snami), who were received at the Ministry of Health by the Ministry’s Chief of Staff, Marco Mattei, alongside Marco Alparone, chair of the Regions-Health Sector Committee. This was the sticking point that the trade unions had hoped to resolve by resuming dialogue with the Minister of Health. Schillaci had always kept the door open, even during the most difficult moments of the reform of local healthcare – when the path forward was a decree, subsequently shelved – which was necessary to finalise Mission 6 of the NRRP.

Immediately following the meetings at the Ministry, the Region-Health Sector Committee of the Conference of Regions approved the policy document paving the way for the renewal of the national collective agreement for general practitioners for the years 2025–2027, and the signing of the agreement between SISAC (Interregional Structure for Contracted Healthcare Providers) and the relevant trade unions could take place as early as the coming days. The Regions’ statement specifies that “the policy document stipulates an obligation for general practitioners to work in community health centres for up to a maximum of 6 hours per week, for 48 weeks per year. This requirement is in addition to the existing obligation for doctors already on an hourly contract to cover night shifts, public holidays and Saturdays, if requested by the health authority. It will, in fact, be up to individual health authorities to determine their own requirements and to distribute them fairly amongst doctors, whilst ensuring a minimum presence of at least one doctor in every community centre”. As regards the trade unions, the organisations – Fimmg, the largest union, as well as Snami and Smi – were heard individually, and issues relating to the policy document for the new general practice contract were discussed in depth.

“Following positive discussions with the Ministry of Health, we are today proposing a reasonable solution by opting for the route of negotiation to ensure that the PNRR target for Mission 6 is fully achieved, in collaboration with all the stakeholders involved,” says Alparone, Chair of the Regions-Health Sector Committee. “We are doing this out of a sense of responsibility towards citizens, who deserve access to local healthcare and services. By approving this policy document, we are laying the groundwork for SISAC and the trade unions to sign the long-awaited agreement in the near future, the terms of which include all the elements needed to ensure the full operation of community care homes.” Once this agreement has been finalised, discussions will begin on the 2025–2027 three-year contract period for the entire general practice sector, with the aim of reaching a comprehensive policy document by 30 September 2026, building on the fruitful cooperation between the parties.