GPs are divided over the strike, with the issue of how many hours they are to spend in community centres causing a rift

On 15 and 16 September, general practitioners belonging to the Smi trade union are going on strike; the union has organised demonstrations and sit-ins in various Italian cities to protest against the recent agreement with the Government on the ‘Community Centres’ introduced by the NRRP and established to strengthen local healthcare services. However, the main union representing GPs, the Fimmg, is not taking part in the strike. After months of wrangling with the government, the Smi doctors’ union is once again taking action, with a two-day strike and demonstrations today in Rome, Rieti, Milan, Palermo, Naples and Pescara. The objection centres in particular on the obligation to work six hours a week within the new facilities: the SMI doctors are calling for this commitment to be strictly on a voluntary basis.

The reasons for the protest relate to the required working hours in community care homes – at least 6 hours – and the single-role model in general practice. The proposals put forward, on the other hand, concern: the establishment of a dual-track system with voluntary access to addiction treatment; the launch of a university postgraduate programme in general practice; the reintroduction of the field of community medicine; the expansion of staffing levels for the 118 emergency service; and the recognition of adequate safeguards (accident cover, maternity leave, etc.). Ahead of the mobilisation, the union’s national secretariat is appealing to all doctors, whether members of the SMI or not, to take united action in defence of the profession. The union also expresses great satisfaction that Petition No. 1451, launched by General Secretary Pina Onotri, calling for legislative measures and dedicated resources for the reform of general practice, has gathered more than 9,300 signatures in 40 days. As mentioned, the focus is on the agreement signed on 23 June between SISAC – the Interregional Structure for Contracted Healthcare Professionals – and the general practice trade unions (FIMMG and FMT, whilst SMI and SNAMI did not sign), under which GPs are required to provide up to six hours’ work per week within Community Centres. The SMI wants this to be voluntary rather than compulsory.

“Whilst we understand the frustration, particularly amongst our younger colleagues who find themselves facing an increasingly complex situation, with unsustainable workloads that are often unrelated to clinical practice”, the Federation of General Practitioners (FIMMG) is not taking part in the strike called by the SMI. This is emphasised in a statement from FIMMG Milan. “Whilst the protest is entirely legitimate and understandable,” the statement reads, “closing practices for two days will not lead to any tangible results. In our view, concrete proposals are needed, in particular contractual solutions that will enable us to strengthen the work of GPs in local practices.” For example, FIMMG, the largest trade union, is actively engaged in collective bargaining with the aim of strengthening medical associations, which in Lombardy take the form of ‘Advanced Associative Structures’. “These organisations, staffed by practice personnel and nurses,” the statement continues, “offer a comprehensive service throughout the day and enable practitioners to focus not only on routine consultations but also on preventive care, the management of patients with chronic conditions, and home care for elderly and frail patients. We would like to be able, within these associative structures, to offer diagnostic services, including telemedicine, which we can currently only provide on an individual basis.” As for the role of GPs in community care centres: “it must not be reduced to second-class healthcare, a sort of daytime out-of-hours service limited to issuing prescriptions and sick notes. This is Fimmg’s commitment at the negotiating table.”