Family doctor reform, doctors on the warpath but Minister Schillaci extends her hand

No to the emergency decree introducing, an historic innovation, dependency for family doctors. No, even sharper, to the loss of the 'personal' relationship with the patient. The doctors in a chorus against the Schillaci reform, which after years of 'stop & go' now seems close to becoming a reality, with the blessing of Prime Minister Meloni, are making a wall. First to lead them, and not just now, is the president of the National Federation of Doctors (Fnomceo) Filippo Anelli. Then, the trade unions, with few distinctions, attack the 'turnaround'. And while the debate flares up, it is the Health Minister himself who tries to put out the fire with an answer to the Chamber's Question Time, which not only 'extends a hand' to the category but also promises its full implementation in the Community Homes. Which are then the real game in the reorganisation of territorial care wanted by the NRP and still, looking at the latest official data, dramatically understaffed. Although even on this point the minister guarantees that everything is proceeding.

But let us go in order. The first to object to the form of the measure by which the fate of our family doctors should be rewritten was Anelli, also a family doctor. "The premise of making an emergency decree to allow doctors to enter community cases clashes with the reality that doctors are already in community homes and that hours can already be done in community homes. So the rationale for urgency is missing,' he said during the conference 'Cooperation in the organisation of territorial medicine in the National Health Service', organised by Legacoop at the ministry. "The reasoning on community houses was born five years ago," he recalled, when with Covid the "need emerged to strengthen a territorial assistance in which doctors had been left alone and that there was a need for an integration of figures. So the community houses were born as a tool for multi-professional integration'. A project from which we are still a long way off. 'To think that in community homes there can only be doctors,' he attacks, 'seems to me to be a failure of this assumption. In these four years of government, I would have expected someone to tell us that they have committed resources to hire nurses, physiotherapists, midwives, technicians to provide a series of answers to the need for health'. Resources that are dramatically lacking, if it is true that 20,000 nurses are missing from the territory, even in the face of disaffection towards the National Health Service and the 'sirens' of higher salaries from abroad. Yet, Anelli concludes, paradoxically they are thinking of 'modifying a medical assistance system that thank goodness works'.

It is clear that Minister Schillaci's reform is 'hot'. It is no coincidence that the tones used in her speech to the Chamber sound, if not like the announcement of a step backwards, then like an attempt to relaunch a dialogue that today essentially involved the regions. The minister's promise is that his reform 'will not dismantle but strengthen' family doctors, today burdened by an unsustainable situation between paperwork and new demands for care in an ageing country. "There are fewer and fewer of them and the profession has lost its attractiveness over the years. Bureaucratic burdens, professional isolation and a lack of career prospects mean that young doctors look elsewhere. Those who remain often heroically hold up a model that is no longer adapted to the health demands of our time. The reform starts here: the figure of the family doctor is not being dismantled, we are finally releasing its full potential. The general practitioner must once again become the guarantor of citizens' health'.

The minister portrayed a family doctor who 'is not just the manager of acute illnesses: he is the guardian of prevention, of education on lifestyles, of chronicity managed on the territory before it becomes an emergency. To do this,' he warned, 'he needs a team, digital tools, and an organisational complex that supports his work'. For this it is necessary to move 'from a healthcare that manages illness to one that builds health, with the citizen as an informed partner and not as a passive user'.

On the new territorial care and the implementation of community homes, meanwhile, 'the debate with the regions has been ongoing since the beginning of the legislature: it has been constructive and operational. The final proposal,' the minister promised, 'will not be plummeted from above, but will be the result of shared work with the implementers who must build and manage these facilities. And with the trade organisations, as in the past, there will be confrontation'.