What does it mean that doctors and nurses must always be available

What does it mean that doctors and nurses must always be available

That the publication in the Official Gazette and the consequent media discussion arrived in the middle of summer is probably little more than a coincidence, but the theme is one that has held the bench almost daily in the last two and a half years: the strengthening of territorial medicine and community. The subject is Ministerial Decree 77, which bears the date of 23 May and entered into force on 7 July, but above all which sets the deadline for compliance in less than a semester (31 January 2023, to be precise). to the new provisions of the law.

Within a reorganization plan involving community houses and community hospitals, with a necessarily articulated system, that made headlines - and has already raised more than a few perplexities and controversies - is the novelty that provides for the availability at any time of any day of the health personnel necessary to deal with health problems both in general medicine and in many specialist areas that provide for patient management outside large hospitals.

Journalistically, this novelty has often been summarized with "doctors and nurses always available", obviously referring not to the individual healthcare operator (who continued he will have a workload according to what has already been foreseen) but to the territorial health structure, which therefore will inevitably have to equip itself with a larger staff to cover a series of shifts not foreseen so far.

From the citizen's point of view it would be a big step forward Without beating around the bush, more than one journalistic commentator has defined this measure - strongly desired by the outgoing Health Minister - the most important political legacy of Roberto Speranza . In fact, the provision provides not only for the generic presence of medical personnel available at a short distance and at any time in the community houses, but also for social workers, obstetricians, pediatricians, psychologists, nurses, rehabilitation technicians and in general doctors specialized in the various disciplines. that can provide for an immediate and on-site management of the health problem (acute or chronic) that occurs. And for the most serious cases, the decree provides that the structure is equipped to allow the patient to reach the nearest community hospital, in order to guarantee the territorial continuity of assistance in all respects.

Black on white in the provision there are also a number of other organizational measures. In addition to the aforementioned community hospital, intended as a small-scale hospital useful for absorbing part of the patient traffic that would flow into large centers, there is talk of home care (also thanks to digital solutions), hospice, management of chronic conditions and etc. In an attempt to ensure the fastest and most efficient adoption of the new measure, the ministry has decided to bind part of the health budget to decree 77. Those who do not comply, in fact, will lose a part of the supplementary financing through the National Health Fund, in a quantified share between 2% and 3%.

Between decreeing and doing ... Despite in principle there cannot be much to object to the provision (on the other hand, it translates into law what everyone has been hoping for even before the pandemic), some perplexity remains on the front of the real applicability of what was foreseen. Each community house, for example, in order to function according to the provisions of the law should have an estimated staff of 30-35 people only including general practitioners and pediatricians, as well as a dozen nurses and all the various specialists available. Many more than are currently foreseen in the organic.

The criticisms of the new law are oriented above all in two directions. The first concerns the parallel presence of a double health track, in which the division of tasks between family doctors and community homes could be smoky if not even conflicting (as is known, in many cases family doctors are now in large numbers insufficient and overworked). In this context, the fear is that the community house will in fact become a sort of outpatient clinic with an adjoining service halfway between a medical guard and a mini emergency room. This is how, for example, the Alliance for the reform of primary care has expressed itself. The second direction is less conceptual and cheaper: to guarantee continuous availability, more personnel are needed, therefore more hires (and stabilization of temporary workers), more turnover when there are retirements and therefore a greater availability of funds. These funds actually exist - in addition to those of the NRP, 91 million euros are expected for 2022, 150 for 2023, then 328, 591 and 1,015.3 between 2024 and 2026 - but the unions' assessment is that are not enough, especially in the first phase.

The last theme is of course the time factor: to believe that in the scarce 6 months that separate us from the deadline set by the decree, this health revolution will take place throughout our national territory he's probably a little too optimistic. However, the important thing, if and when concrete changes begin to arrive, is that the direction is the right one, even if probably just a handful of virtuous cases will really adapt within the set deadlines.

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