GPs at community centres: here’s who will have to go there and what they’ll be doing
General practitioners are joining community care homes, and they do so with specific obligations, but also with a new remuneration package
Key points
The new National Collective Agreement for the implementation of Investment 1.1, ‘Community Centres and Patient Care’, which forms part of the National Recovery and Resilience Plan (PNRR), marks a significant change for them and for the Italian local healthcare system. The main objective is to strengthen the primary care network, improving patient care and ensuring greater access to treatment. Under the terms of the agreement, general practitioners in the single primary care role will work within Community Centres (CdC), facilities that form the cornerstone of the new local healthcare organisation. These doctors, who may hold either fixed-term or permanent posts, will provide care on an hourly basis, following the guidelines of their respective Local Health Authority (ASL).
Which doctors are subject to this obligation, and what are the working hours?
The main change compared with the past is that, previously, work in the CdC was optional: the agreement at the start of the year provided for at least four hours on a voluntary basis, but nobody in Italia actually did this, hence the need to make it compulsory.
In the absence of specific regional agreements – which nevertheless remain valid, particularly if they offer higher remuneration – the obligation to work in the Community Centres (CdC) is now binding on doctors. Doctors already appointed on permanent contracts under the ‘ciclo di scelta’ scheme, who have not agreed to fulfil their weekly commitment (both in terms of the hours to be guaranteed at the surgery and the services to be provided in the district), are obliged to work up to six hours a week in the Community Centres. These hours must be spread from Monday to Friday, between 8.00 am and 8.00 pm, at the locations specified by the Local Health Authority (ASL). The Local Health Authority is responsible for determining the number of hours required to ensure the Community Centres’ operations and for allocating the remaining requirement amongst the doctors practising within its area of jurisdiction. This represents a change from the past, when the allocation of work in the Community Health Centres was less regulated and often depended on regional or local agreements.
What will they be doing in the community homes
Another new aspect of the agreement concerns the organisation of work. Doctors may agree amongst themselves on a different arrangement of their allocated hours, provided that a continuous presence of at least three hours at the community centre is guaranteed. This shift should enable the doctor to carry out all those tasks that ‘traditionally’ fall within their remit. In particular, in community care centres, the general practitioner works in an integrated manner with nurses, specialists, social workers and other professionals; they identify frail and chronically ill patients, draw up and update care plans, coordinate the course of treatment and monitor adherence to therapies. All the whilst – just as in their own practice – continuing to carry out medical examinations, prescribe medication, request tests and specialist consultations, issue medical certificates, and conduct periodic check-ups, not least to prevent unnecessary hospital admissions. However, it is mandatory to provide prior notice to the District, specifying the timetables and the doctors who will be providing the service. The aim of this system is to ensure consistent and coordinated cover, thereby improving the efficiency of healthcare facilities and the quality of care.
Remuneration and obligations for local health authorities
As regards remuneration, the new agreement stipulates that doctors shall receive an all-inclusive payment of 38.72 euros for every hour of work carried out in the CdCs. This amount includes an insurance contribution of 0.72 per cent, calculated on the basis of component A of the remuneration (the national per capita allowance). Unlike in the past, when remuneration could vary according to regional agreements, the ACN stipulates that rates are to be determined exclusively through national collective bargaining. However, the regions may provide for additional payments for specific duties, allowing for a degree of flexibility.
