Community homes without doctors and nurses, how regions try to avoid a flop

Are the Community Centres (CdCs) financed with 2 billion lire from the NRP and created to guarantee examinations, first examinations and prevention at risk of a flop? The Ministry and the Regions are looking for viable solutions, but the crux is clear: without personnel, many centres risk remaining on paper or functioning only half-heartedly, amid union resistance and political disagreements. The NRP provided for 1,350 Community Homes, later reduced to 1,038 with the 2023 remodelling. The programming agreed with the Ministry of Health, however, has risen to 1,715 facilities; the extra-Pnrr quota should be covered with funds from Article 20 of Law 67/1988, cohesion funds, the Fund for non-deferrable works and regional or provincial resources.

The latest Agenas survey, less than a month before the Pnrr deadline of 30 June 2026, counts 781 CoCs with at least one active service. But only 204 have medical presence in accordance with DM 77/2022 and 216 nursing presence: hence the estimate of more than 2,500 doctors and almost 7,000 full-time nurses missing. The risk is not automatically losing European funds, because many facilities are outside the NRP or financed through other channels. The real risk is health and organisational: buildings open but without effective care, doctors, nurses, specialists, PUAs (single access point), home care and stable connection with the territory. The regions are therefore looking for room for manoeuvre. The answers change, but the point remains the same: the success of the CoCs depends on the personnel, not just the sites.

After Minister Schillaci's proposal to provide for SSN-employed doctors in the CoCs, which was rejected by the trade unions and the government majority, the Veneto Region has relaunched another hypothesis: using more doctors already employed by the National Health Service, hospital and territorial, including outpatients of the ASLs, for some activities in the Community Homes. This route has also met with a rejection from the hospital unions, due to contractual constraints and the risk of weakening already understaffed hospitals. The idea, however, is not to transfer doctors permanently out of the hospitals, but to allow hourly activities in the CoCs, territorial specialist services, and more integration between hospital and territory. The logic is simple: if recruitment does not arrive in time, we try to make better use of professionals already in the system. Other regions are moving in the same direction, with solutions that are more or less mature and often still to be verified in the field.

Emilia-Romagna and Tuscany start from a strong territorial tradition. The first integrates GPs, paediatricians, outpatient specialists and CoCs in a deep-rooted multi-professional network. The second makes the most of Case della salute, AFT, outpatient specialists and family nurses: many GPs remain affiliated, but work partly within the CdCs. Veneto and Lombardy use more organisational levers. Veneto also focuses on telemedicine and remote specialists. Lombardy reasons on AFT (functional territorial aggregations), general medicine agreements, cooperatives, external professionals and accredited private: a flexible platform, but with risk of fragmentation. Friuli-Venezia Giulia is working on hospital-territory continuity and territorial nursing, with a greater role for nurses in the management of the chronically ill and in the coordination with GPs, specialists and social services. Piedmont is experimenting with shared teams between districts and specialists over several CoCs, to avoid fixed staff in each location. Trento is looking at advanced skills nurses for follow-up, chronic conditions and, where possible, limited prescriptions, and declares the PNRR targets for Community Homes and Hospitals achieved. Bolzano has planned 10 CoCs with gradual openings, albeit with the problem of personnel in peripheral and bilingual areas. Liguria, Latium, Campania, Marche and Valle d'Aosta offer specific examples: telemonitoring and nursing services also in pharmacies; the Asl Roma 2 network with 22 CoCs and 2 OdCs (community hospitals) completed; the Campania operating model adopted by the Asl; Health Points and IFeC training (family and community nurses) in Marche; direct access outpatient clinics in Aosta and Châtillon. Puglia and Sardinia focus on family nurses and multi-presidency models with telemedicine.

The following table summarises the regional picture as of 1 June: some initiatives are operational or at an advanced stage, others remain acts of policy. The difference is whether there are staffing, shifts, services and intake behind the locations.