“We need to think about a reform of community medicine, which enhances the role of general practitioners. Community care is essential, I do not lean towards a strictly hospital-centric vision. The decline in hospital beds over the years, together with the lack of development of community medicine has led us to these critical issues that we see today”. These were the words of the Minister of Health, Orazio Schillaci, during his speech in the Senate Health Committee. The minister underlined how the lack of adequate development of community medicine has contributed to the current difficulties of the health system.
Two bills to strengthen territorial and hospital assistance
“In the next budget maneuver, the ministry has committed to developing two connected bills, aimed at strengthening territorial and hospital assistance, as well as the reform of the health professions, which I intend to define and bring to approval as soon as possible”. Schillaci specified that the reform of the health professions is a priority for the government, and that this must include a review of the role of primary care doctors: “No real health reform can have hope if the role played by primary care doctors is not reviewed”.
The contribution of general practitioners within community homes
According to Minister Schillaci, regardless of the contractual rules, It is essential that GPs provide a concrete hourly contribution within the National Health Service (NHS). This contribution will be provided in the facilities responsible for providing community medicine. Schillaci added: “Without going into the merits of the type of contract, even if for many regional presidents general practitioners should become employees of the National Health Service, I believe it is essential that general practitioners work a certain number of hours ensuring that work within community homes”.
Compliance with the objectives of the PNRR Health
The minister then reiterated the government’s commitment to achieving the objectives set out in the PNRR Health. “We are respecting all the objectives of the PNRR Health to ensure the full operation of Community Homes and Hospitals by 2026 and by the end of 2024 of the Cot, the territorial operations centers. As regards the Community Homes, 538 construction sites have been started to date, or 52% of the expected target. 167 construction sites have been started for Community Hospitals, 55% of the expected target.” The strengthening of territorial assistance, according to Schillaci, will also have positive effects on hospital assistance, in particular with regard to the reduction of overcrowding in emergency rooms.
Staff shortages in the national health system
Schillaci highlighted another crucial problem: the lack of personnel in the National Health Service. “According to data from the Ministry of Health, today there is a national shortage of 4,500 doctors and 10,000 nurses in emergency rooms. We have intervened against the phenomenon of ‘tokenists’, which has operated with deleterious effects, and against the improper exodus from the NHS, we have also intervened to reduce outsourcing”.
Lack of contracts in emergency-urgency
Another problem is the scarcity of contracts in the emergency-urgency field. Schillaci illustrated the data: “In 2021, only 500 contracts were assigned, or 47% of the available positions; in 2022, it dropped to 340 contracts, 42% of the available positions; in 2023, only 245 contracts were assigned, just 29%.” This trend is found not only in Italy, but also in other countries such as the United States, where more and more young people are choosing to specialize in other medical sectors.