2023-12-18 23:17:14
BarcelonaThe lack of pediatricians in primary care is endemic: historically it has affected small towns and rural areas, but now it has also become a problem in medium and large cities. Across the country, more and more families are having problems visiting their reference centers, either because there are no professionals available – there is little interest among students in training as a primary school pediatrician – or because they work there only a few hours a day. Often, therefore, many of the families of the million children up to 14 years old living in the country have to go to other nearby CAPs to be able to receive care. The solution that the Department of Health is now proposing to alleviate the shortage of hands, although it is still in its infancy, would be twofold: in territories where it is difficult to guarantee pediatric care, a network of pediatricians will be created that will travel to be able cover the vacancies and leave or the service will be concentrated in some CAPs so that it is the families that have to move.
The two options have been applied both formally, in the case of the creation of parent teams in the form of a pilot test, and informally, in the case of the displacement of families, but now the idea of Salut is to institutionalize them. Looking ahead to next year, the ministry must have 79 territorial teams of pediatric care (ETAP), which will have their own direction and will be made up of between 8 and 15 pediatricians and 8 and 15 pediatric nurses (not necessarily with the same proportion), in addition to other specialists in pediatric care. There are currently 25 of these teams in operation, and by the end of 2024 all 79 should have been deployed.
The department’s idea is that they be located within some CAPs, although other spaces that it has not specified are not ruled out. In any case, the ministry is committed to guaranteeing that journeys to get there do not exceed 30 minutes, explained the head of Pediatric Health Care, Gemma Ricós. Each team will be assigned between 5,000 and 25,000 children and young people, so the number of 79 teams could increase if needs increase. As for which territories would accept one option or another, Salut has not yet specified it, and says that the decision will depend on the characteristics of each territory, such as geographical dispersion, socio-economic vulnerability or the number of children who reside there .
Salut ensures that all children and adolescents will have a pediatrician and a pediatric nurse of reference. Councilor Manel Balcells has stated that the model to be deployed is “very complete” and “absolutely necessary to guarantee quality” in pediatric care. In this sense, he has recognized that “there is no equity throughout the Catalan territory” and that there is “a certain discomfort” due to the lack of paediatricians.
Criticism of neighborhood organizations
This deficit of paediatricians in the CAPs can be explained, above all, because the professional career is unattractive. Most professionals choose to work in hospitals because they get paid more, they can do guard work there and they can grow in the research field there. On the other hand, in primary schools they often don’t even have their own equipment that allows them to collaborate with each other. With this model, the ministry argues, a network of at least four pediatricians per territory will be guaranteed.
Social entities in neighborhoods with a structural deficit of paediatricians, such as Turó de la Peira and Nou Barris, in Barcelona, or in Sabadell, and movements for public health such as the Catalan Primary Care Forum (FoCAP) and Marea Blanca plan to a press conference this Tuesday to denounce that the model “leaves thousands of children without local assistance”. They have been mobilizing locally for some time to “recover” services in each neighborhood and this proposal goes against their demand. All in all, Balcells has moved ahead of the criticism. “These changes are to improve care. Everyone wants the children to be well taken care of, not just taken care of,” he replied.
The president of the Catalan Pediatric Nursing Association (ACIP), Susanna Campo, has also urged families to see the proposal “as a gain and not as a loss”. “Considering that in some territories there is a lack of a pediatrician, when the population is all together and aggregated, it may take five minutes more, but it will have a pediatrician on all shifts. This is quality”, he stressed. In addition, the president of the Catalan Society of Paediatrics (SCP), Anna Gatell, estimates that around 36% of children outside the metropolitan area of Barcelona are treated by family doctors or non-specialist doctors. In this regard, he pointed out that the new model will favor territorial equity and the optimization of resources.
A specific 061 for children
Salut will also strengthen the 061 Salut Respon by incorporating a specialized line for children. There is now an intensivist pediatrician for serious or critical children, who provides telematic support to primary care professionals and advises them from the Medical Emergency System (SEM). From June of next year, however, 061 will be expanded with the figure of a pediatrician specializing in primary care and emergencies for patients who are not serious or critical with non-face-to-face care. The aim is to solve the child or adolescent’s health problem or doubt to avoid unnecessary trips or to guide families in the next steps they must follow, for example if they need to be visited in a health center . According to data from 2022, the SEM receives close to half a thousand pediatric consultations every day.
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