Community care homes: what the agreement entails for GPs and the unresolved issues

‘Better late than never’ is the first comment that springs to mind regarding the situation of GPs in the Community Centres, which seems to have been resolved – at least for now – with the agreement signed on 23 June at SISAC. Another inevitable thought might be: couldn’t they have thought of this sooner? Given that the Agreement, which was finalised just a few days ago, had actually been signed on 15 January, the question seems entirely legitimate, particularly in relation to the 30 June deadline – a date that had been known for some time and was non-negotiable in terms of its timing and consequences. But, as is well known, there have been many variables in this affair, some of them quite complex. The initial intention of the Regions and the Minister of Health to introduce a landmark reform with the transition to direct management, the proposal for a decree-law, the withdrawal of the emergency measure under pressure from the Government itself, right up to the signing of the agreement within the space of a few days. Let us briefly recap what happened.

On 16 June, the Regions-Health Sector Committee approved the policy document paving the way for a National Collective Agreement, limited to defining the role of general practitioners in Community Centres. A negotiation meeting was convened for 22 June, and on 23 June the draft National Collective Agreement (ACN) was signed for the implementation of the PNRR investment in Community Centres, as part of Mission 6. Finally, on 26 June, at an extraordinary meeting of the State-Regions Conference, a favourable opinion was issued on the text of the preliminary agreement. Nevertheless, the Conference’s press release states: ‘thanks to the agreement reached today and the positive opinion of the Court of Auditors …’. With regard to this last passage, it is true that on 23 June the Court of Auditors filed Resolution No. 18/SSRRCO/CCN/2026 with the secretariat, but this was the publication, a full six months later, of the audit report on the draft ACN signed on 5 November 2025. It is not, therefore, the certification referred to, and it was, moreover, unthinkable that the Joint Sections, meeting in an audit capacity, could provide certification on the compatibility of the costs of the Supplementary Agreement within a few hours.

In this regard, it should be noted that the negotiation procedures for agreements on state-funded healthcare are conducted in a manner analogous to those laid down by Legislative Decree 165/2001 for the civil service, with SISAC taking the place of ARAN. This has been the case since 2003, but in this specific instance it appears that the procedure has been somewhat rushed because, amongst other things, there is no news of the Ministry of Economy and Finance’s (MEF) opinion or the Government’s approval. Therefore, the process followed is decidedly atypical, but the preliminary agreement is supported by the political agreement signed with the Minister of Health, Orazio Schillaci, and the President of the Conference of Regions, Massimiliano Fedriga, which provides for the drafting, by 30 September 2026, of the policy document for the renewal of the ACN for the three-year period 2025–2027, which is likely to incorporate the proposal of 23 June.

The text of the preliminary agreement was signed by SISAC and the trade unions FIMMG and FMT, whilst SMI and SNAMI did not sign. The Agreement was therefore concluded by a majority, which is, moreover, clearly defined, given that the two signatory organisations account for more than 70 per cent of the negotiating table (64.91 per cent and 5.57 per cent respectively) and the other two account for 18.34 per cent and 9.05 per cent. The text of the Agreement consists of just four articles and can be summarised as follows:

- the ACN of 15 January 2026 is amended and supplemented, and operational provisions are introduced regarding the presence of general practitioners in Community Centres;