Family doctors, Schillaci confirms: employees or freelancers. What changes for patients

Family doctors will be able to choose whether to remain under an agreement with the National Health Service, and therefore work as freelancers as happens today, or whether to become employees. Confirming the imminent arrival of the "dual channel" option for the long-awaited reform of family doctors - anticipated in recent weeks by Il Sole 24 Ore - was Health Minister Orazio Schillaci interviewed by Corriere della Sera: "I believe that on this issue it is right to let doctors choose whether to continue to be freelancers or become employees of the NHS". To stem the flight of family doctors, a shortage that has created a real emergency in some areas of the country, it must also be made "attractive again to be a family doctor, there is a vocational crisis. Today there is not a wide participation in competitions. It is necessary to launch a reform that provides for a national university specialization school", added the minister. Among the key points is also the obligation to dedicate a certain number of hours in the new Community Houses: the hypothesis is at least 18 hours a week.

The latest drafts circulated at the State-Regions conference confirm what the Minister of Health Orazio Schillaci hoped for the now imminent reform of primary care. The option of the provision - there is also talk of a simple ministerial decree that starts from what was foreseen by the law establishing the NHS (833 of 1978) where there was already a double option - will therefore be that of an intermediate solution, compared to the hypotheses circulated in recent months, always leaving citizens the possibility of choosing their reference doctor who in turn will be able to decide whether to remain as a freelancer in his medical practice or become an employee, perhaps working in the new Community Homes. The central theme is to make local medicine work better, where the family doctor plays an absolute leading role. But what changes for the patient? The citizen will continue to choose his trusted family doctor who will be able to work in the practice - therefore as a freelancer contracted with the NHS - with opening hours of a few hours a day as happens today or he will be able to choose a doctor inside the Community Home. In the latter case, it will be a doctor employed by the National Health Service who, during the opening hours of the Community Home (12 hours a day), may also be replaced by another doctor, with the possibility for the patient to also access some diagnostic tests such as electrocardiograms or spirometry that can be found in the new facilities financed by the PNRR.

"We need to have more family doctors, who are the first point of contact between citizens and the NHS. Then there is a broad debate on this figure, I believe it is essential that general practitioners spend part of their time within the structures of territorial medicine provided for by the PNRR, I am referring to the Community Houses, where within the multidisciplinary teams provided for, a fundamental figure is the family doctor", added Minister Schillaci. This passage also appears in the draft texts of the reform in circulation. For now, the "hourly debt" of family doctors to be carried out in the new NHS structures in which the PNRR invests 2 billion has not yet been decided, but the most likely hypothesis is that we start from a minimum of 18 hours per week within the Community Houses. In practice, those who remain in their own practice, as today, will still have to work within the new Health structures on the territory.

Schillaci concluded by explaining that the category is expected to "collaborate fully to continue doing what they have always done over the years. We will soon have a solution in the primary interest of citizens, the sick and the vulnerable". "In the face of this lack of vocation, we do not need botched reforms, but more resources to invest in making specialization more attractive", replies the secretary of the Italian Federation of Family Doctors (Fimmg), Silvestro Scotti . The reform, well-regarded across the board by some political forces and regional governors, arises from the need to implement the National Recovery and Resilience Plan, but continues to encounter opposition from the main trade union in the category. "We are willing to sit down at a table - says Scotti - and make our contribution to the Community Houses but we do not find benefits in the transition to dependence, even if it were configured as voluntary". According to Scotti, the first to pay the price would be the citizens: "In Spain and Portugal - he explains - there is a system of primary care with dependent doctors. To book a consultation you go through a platform and the direct dialogue between doctor and patient has disappeared. The doctor works in shifts, respects service hours, and outside of those he does not answer the phone".