GPs in community centres: hourly pay of 38 euros for up to 6 hours a week is now in place

A basic agreement has been reached governing the presence of GPs in community care homes. Following weeks of discussions and controversy, the relevant trade unions have reached a preliminary agreement with SISAC (the Interregional Structure for Contracted Healthcare Providers), and the final agreement was signed this evening following the go-ahead from the Ministry of Economy and Finance (MEF). This is a decisive step ahead of 30 June, the deadline set by the National Recovery and Resilience Plan (PNRR) for the 1,038 new local facilities to become operational. Health Minister Orazio Schillaci has welcomed the development, although the trade unions were not united on the issue and two – SMI and SNAMI – have decided to reject the agreement. An hourly rate of around 40 euros (38.72 euros plus social security contributions) is on the table at national level. Doctors will be required to work up to 6 hours per week, based on the needs identified by the regions, for 48 weeks a year.

As negotiations gathered pace, a draft agreement governing the work of general practitioners in community care homes was signed this evening. It was signed by SISAC, representing the regions, and the trade unions FIMMG and FMT. The contract provides for the introduction of an obligation for doctors to work up to 6 hours per week for 48 weeks a year in community care homes between 8.00 am and 8.00 pm, with a shift of at least 3 consecutive hours. For each hour worked in the community centres, doctors are guaranteed a fee of €38.72, plus social security contributions (€40 gross), in accordance with a single-rate system applicable throughout the country. “We are in talks with the trade unions and the regions and hope to reach a solution shortly. We are optimistic and look forward to reaching a conclusion. There is a basic agreement,” Schillaci announced. He added: “We are keen for general practitioners to be based within the community health centres – the new local facilities – because they are the ones who know the patients best. This will lead to a more modern healthcare system that is more localised and closer to the public, and I hope it will also help relieve pressure on A&E departments.” Shortly afterwards, confirmation also came from the regions: “There is consensus on the proposed national collective labour agreement for general practitioners regarding the implementation of Community Health Centres,” the Conference announced, also confirming its intention to begin discussions as soon as possible on the 2025–2027 three-year contract period, with the Regions committing to issuing the policy document for the entire general practice sector by 30 September 2026.

 Staffing the new facilities with a sufficient number of doctors to provide citizens with the necessary local healthcare is the priority: this is why Minister Schillaci had proposed an ad hoc decree, an approach that was subsequently shelved following controversy and opposition from the doctors’ unions. The agreement now reached therefore resolves the impasse by setting out a national framework, as called for by the minister himself, and preventing each region from proceeding independently. The agreement requires GPs to work in Community Centres for up to a maximum of 6 hours per week, for 48 weeks a year, with an hourly rate of 38.72 euros. This measure 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, within the limits of the allocated financial resources, whilst ensuring a minimum presence of at least one doctor in every community centre. In recent days, Schillaci has also opened up the possibility that hospital doctors might work in community care homes on a voluntary basis and outside their normal working hours, thereby removing certain incompatibilities.

The largest of the GPs’ trade unions, Fimmg, has given the green light to the agreement, arguing that this demonstrates the profession’s sense of responsibility. Because, “at this stage,” explains the union, “it is necessary to balance several requirements: the sustainability of general practitioners’ work, the country’s need to meet the targets set out in the National Recovery and Resilience Plan (PNRR), and the duty to avoid the return of funds, which would have extremely serious consequences for the funding of the National Health Service and, consequently, for the public”. On the other side are the trade unions SMI and SNAMI, which have announced that they will not sign the agreement tomorrow. The SMI denounces that “a fundamental change is underway to the legal nature of the employment relationship that currently governs the practice of general practitioners within the National Health Service under the framework of private practice under the National Health Service scheme”.