The challenges of healthcare

The family doctor player in future health

Community Homes by 2026, financed with 2 billion euro from the NRP: but family doctors must work there to function

12 June 2025

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Once upon a time there was the family doctor, 'the doctor' who came to visit at home, perhaps with the Fiat Seicento in the countryside or with the 1100 in the city. Will there still be, as a fundamental junction of that territorial medicine that we all see as the new frontier of home care to ease the pressure on emergency rooms? Or will it remain the figure of today, the doctor who moves further and further away from care to become just a centre for 'dealing' prescriptions to be taken to the pharmacy and little more?

Unfortunately, it is now common in the thinking of many people that the family doctor is no longer the main point of reference for one's state of health, promoting disease prevention and guiding us towards early diagnosis and specialist medicine when necessary, but a mere prescriber of prescriptions. As a citizen and as a doctor, I find this assessment humiliating, and I do not share the controversy that pits politics on one side and professional associations on the other, with a debate that has already become a dialogue between the deaf.

But now there is a topic for concrete discussion: on Minister Schillaci's table is the draft reform for family doctors, drawn up by the Regions and viewed by the Ministry of Health. The objective is to move from the historical figure of the family doctor, the one that was born after the Second World War, but which has much older historical and cultural roots in a model of traditional and community care, to a role as an effective player of one of the main drivers of home care and of the link between hospital and territory, that is to say, well beyond the current prescription dispenser. Here it is necessary to go to the root of the conflict, that is, to move (and deliberate for those who have the prerogatives to do so) on the basis of a demographic and social scenario that is completely different from that of when the National Health Service was born, with the ageing of the population, on the one hand, the need to care for the population of immigrants who help the country in so many jobs (starting with home care for the elderly) and the very strong specialisation of modern medicine, on the other. From this point of view, the only one that counts, the controversy over the role of the general practitioner is nothing if not a reflection of a profound conflict between two models of health care: one more traditional and person-based, the other more centralised and performance-based. This clash touches issues such as the professional identity of the doctor, the organisation of the territory, and the rights of the citizen-patient.

The limits of community medicine explode with the arrival of the pandemic: the Regions are forced to take note of the failure and in order to offer assistance to citizens every day, from 8am to 8pm, the Community Homes are born, public facilities to be built by 2026 and financed with 2 billion euros from the NRP; to function, however, family doctors must work there and, therefore, in 2022 the government of the time proposes a change to guarantee, albeit with a para-subordination relationship, 38 hours of work per week: 20 in their own practices and 18 in the Community Homes. These provisions never become law and, in fact, the current agreements guarantee 5 to 15 hours in the practices, depending on the number of patients, and 6 in the Community Homes.

The regions, meanwhile, have been working on a reform that could radically change the relationship between family doctors and the National Health Service.

The cornerstones of this reform start with specialisation for primary care physicians. Possibility of opting for dependency, as well as the transformation of the current conventional model into forms of accreditation, preferably for groups of doctors working in Community Homes. And again: the opportunity is envisaged for contracted doctors to opt for medical management with facilitated paths for the recognition of qualifications.

Now, over and above the opinions that each of us may have on the proposed organisational review, which in any case must be brought home with an effort of mutual understanding between the autonomy that family doctors have enjoyed up to now and the absolute necessity of their role in the territory for the health service, it is appropriate even in this delicate negotiation to have as a reference the unification of the care pathway, which appears fragmented and in discontinuity of care with specialist and hospital medicine. We also encounter this organisational criticality in hospitals, where individual services are provided without the continuity that the treatment of a health problem requires. Healthcare workers know that the unitary care pathway is the solution to the current difficulties, but they also know that its application requires a genuine paradigm shift, since the treatment of a health problem requires a true taking charge of the sick person through a pathway where the individual diagnostic and therapeutic services are provided with continuity of care, not only within hospitals, but also with the territory. This continuity of care is made possible not only by dialogue, but also by digital tools that facilitate the sharing of health data and communication between the different actors. This is how care based on the centrality of the patient in his or her health needs is pursued. This is how we restore dignity to that proximity medicine, considered a fundamental step before and after specialist and hospital medicine.

This is the architecture of the health service that will be able to guarantee adequate access to care according to the principles of universality, equity and gratuitousness, together with cost sustainability. And it is an architecture that is becoming a content of organisational reform that moves in the places of care (territory-hospital-territory) and in time (care on the needs of the disease and not on where and when to chase it with services). Minister Schillaci is aware of the need for this change of pace and has set up, on the basis of the indications of the last budget law, a technical round table with the task of drawing up concrete proposals for the organisational models that the Regions will experiment on their own geographical area. A technical table that expects to conclude its work as soon as possible. I am confident that this season of silent and proactive reforms will see all the actors in the health sector united to adapt the health service to the current challenges as the guarantor of health protection in our country. This is a right for today's citizens but also a duty in the interest of future generations. And, within this framework, it is in the interest of the citizen-client of the Public Service that the family doctor should return to being 'the doctor' of the past, that is, translated into today's terms, one of the most important pivots of the decisive junction of care between the territory and the hospital, inbound and, also and above all, outbound.

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The family doctor player in future health

Community Homes by 2026, financed with 2 billion euro from the NRP: but family doctors must work there to function

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