GPs: the latest confirmation – the reform will not go ahead; the agreement remains in place

It is now official: the reform of general practitioners, which, under a decree-law, provided for the integration of GPs into community care centres and the transition to salaried employment for some of them, has been withdrawn. The decision, which had been known for days – as reported several times by Il Sole 24 Ore – was reportedly communicated by the Chief of Staff at the Ministry of Health Marco Mattei to the regional health councillors. The decree is expected to be replaced by an agreement to be approved in the policy document of the family medicine agreement, which is due for renewal. The idea is to include a commitment of at least six hours per week to be spent in community centres. But time is running out, given that the end of June marks the deadline for the NRRP, which sets a minimum target of opening and operating at least 1,038 community centres – large-scale clinics where citizens will receive consultations, initial tests and preventive care. The risk now is that several facilities – particularly in central and southern Italy, where the greatest delays are being recorded – will become empty shells without medical staff or services.

The draft, presented by the Minister of Health Orazio Schillaci to the Conference of Regions and subsequently revised by them, had never been formally submitted but had become the subject of controversy and clashes with the trade unions, who were demanding to be involved in decisions that directly affect them. What is striking about this affair, however, is the resounding halt imposed from within the majority itself on the reform that Schillaci had been working on for weeks, having also secured the agreement of the Regions. The Regions had been putting pressure on the minister himself to find urgent measures, such as hiring a contingent of doctors as employees to staff the most understaffed community care homes. An option viewed as a smokescreen by the unions, in particular the FIMMG, which was ready to stage strikes and protests to defend the current agreement with the NHS (medical staff are self-employed), 'threats' that convinced the majority parties – first Forza Italia and then Fdi and Lega – and the Prime Minister herself Giorgia Meloni to backtrack.

Now that the idea of the decree has been shelved, attention is turning to Plan B: the Ministry of Health’s aim is now to speed up the new agreement (covering the three-year period 2025–2027) to be signed with GPs: the ambitious aim is to finalise the text of the new ACN – the national collective agreement which the regions must then implement locally – by June, stipulating a ‘mandatory working time’ of at least six hours per week that GPs must spend within the new facilities. Just for 2026, just under 300 million euros would be available to incentivise them to work in teams with the other staff who are expected to staff these facilities (specialist doctors, nurses, etc.). It will soon become clear whether this approach will be sufficient. The halt to the reform concerning GPs has sparked the ire of the very person who had defended it most of all: the Lombardy Region’s Health Councillor Guido Bertolaso. According to regional sources, Bertolaso, who was present at the meeting between officials from the Ministry of Health and the regional health councillors, walked out of the meeting and announced his resignation.