Family doctors: reform remains in the balance and regions reject SSN reorganisation bill

The reform of family doctors is creaking more and more, but for the moment it remains in the balance despite the wall raised by the trade unions ready to strike and mobilise in the coming days, even if there is no lack of distinctions within them. The real risk now is that without immediate action, the appointment with the opening at the end of June of more than a thousand Case di comunità - maxi clinics financed with two billion lire from the NRP where visits, examinations and prevention can be carried out - will turn into a resounding flop.

The most recent Agenas report photographing the situation last December told of only 4% of facilities with all services active, mainly due to the lack of doctors and nurses. Hence the urgency of a reform of family doctors to be made to work also in Community Homes, supported first and foremost by the Regions, so far united, and by Health Minister Orazio Schillaci, who had shared it with the same Premier Giorgia Meloni, who less than a month ago had invited Schillaci to go ahead. A position that could now falter in the face of the category's altolàs and the doubts that are swirling within Fratelli d'Italia, the premier's party, after Forza Italia's stop.

In the meantime, the Regions have rejected the other reform desired by Schillaci, namely the proxy decree for the reorganisation of the National Healthcare System, which aims first and foremost to revise the hospital network: "We would have expected a different and preventive involvement, not ex post," explained Massimo Fabi, councillor for Emilia and coordinator of the Health Commission of the Conference of Regions, who is expected to request the formal withdrawal of the decree tomorrow and "the opening of a debate with the Regions in the name of loyal cooperation. A method, this one, of collaboration that was followed in the case of the reform of family doctors, which saw, after several discussions, the drafting of a draft decree shared by all the governors concerned about the possible flop of the Community Homes: the core of the reform, which has been retouched as we go along, envisages a dual channel for recruiting family doctors, of whom there is currently a great shortage, so much so that we have fewer than any other in Europe, and that is, on the one hand, to maintain as a priority the current channel of the agreement - the doctors remain freelance professionals working for the NHS - and on the other hand, but only as a 'residual' option, to hire a contingent of them as employees of the health service to assign them to the areas where there are the greatest shortages, starting with the community centres, which risk opening empty. This last possibility is seen as a smokescreen by the unions, especially by the largest one, the Fimmg, which even on World GP Day relaunched its 'no to a reform that is unacceptable both in method and merit', threatening to go on strike if the government intends to go ahead. The other unions - Smi and Snami - are instead less rigid on the hypothesis of only residual dependency.

The unions' indications were sent yesterday to the Ministry's technicians, who should now make use of them to modify the text. But the FIMM's rejection weighs heavily, proposing to immediately draw up a new national collective agreement to include the measures and the hourly debts to be spent within the community centres, leaving the convention intact and postponing the revision of the whole of general medicine to a future reform bill. But will the convention, with all the necessary regional agreements to be made in a very short time, be enough to fill the new structures that are supposed to thin out the too many admissions to the emergency room? The doubt is more than concrete, but the road to (albeit 'residual') dependency for family doctors - a path followed in Spain and Portugal, for example, and with mixed forms in other European countries - now seems increasingly uphill.