"New rules for general medicine in favor of disadvantaged territories", the proposals of councilor Doria to the ministry

There are numerous proposals that the Sardinian regional councilor Carlo Doria has put on the table of the Ministry of Health . They range from more places available to students who want to enroll in the Faculties of Medicine of the Universities of Cagliari and Sassari to the new rules for identifying the lack of general medicine.

There are mainly two requests made : the authorization to increase by about a third, for at least three years, the places available for enrollment in the degree courses in Medicine and Surgery in the two Sardinian universities, and the launch of a negotiation at national level for the modification of the parameter currently in use to identify the lack of general practice and their ban, from one doctor every 1,000 inhabitants to one every 1,200 for urban areas with a population of over 20 thousand inhabitants, maintaining instead the doctor/population ratio is unchanged for areas with fewer inhabitants.

«The problem related to the shortage of general practitioners in many areas outside the large urban centers is common to all of Italy and has distant origins - explains Doria -, starting with a failure to plan turnover with a clear imbalance between retirements and entry into the national health system . In this context, an anti-historical number programmed in admissions to the degree course in Medicine and Surgery is included. This imbalance, made more evident by the numerous retirements of medical personnel in recent years compared to the new entries, has shown - he adds - the extreme vulnerability especially on the territorial health side with large sections of the population, especially in peripheral areas, currently deprived of the presence of general practitioner, but also, sometimes, the pediatrician of free choice".

The ratio of one doctor for every 1,000 inhabitants , which defines the current distribution of offices lacking general medicine to be banned , is no longer adequate to give answers to the territories , according to the exponent of the Solinas council: «In order to better understand what does not work and what we are intervening on is good to know the numbers at stake: today in Sardinia there are 979 doctors in charge of the office (as of 31 January 2023). To these are added about 200 doctors who today have the qualifications to participate in the next call for assignment of offices lacking general medicine, 418 throughout Sardinia. If each of the over 1,100 general practitioners were maximalist, i.e. had 1,500 patients in charge, the people assisted would be 1,650,000, more than the number of adults present in Sardinia».

"However - declares the councilor - the current distribution of general practice offices, according to the parameter of one doctor for every thousand inhabitants, determines an imbalance with a concentration of doctors in large urban centres, which are more in demand, while in the peripheral offices there are the strongest shortcomings. The modification of the parameter would lead to a slight decrease in the seats available in the metropolitan areas, which in any case would continue to be covered in a satisfactory manner, to the advantage of the more peripheral areas".

Finally, on the doctor/inhabitant ratio currently in use: «In the past, when the number of general practitioners was greater, it could have been considered an adequate condition, but at present, having lost about a third of general practitioners in Sardinia compared to ten years ago, we find ourselves with a parameter that inevitably ends up favoring large urban centres, which are more coveted and assigned, without then having available resources capable of responding to the needs of peripheral territories. It's as if we wanted to fight this new battle with yesterday's rules of engagement when we had a larger army».

"Pending a national provision, the Region - Doria continues - has started a negotiation with the unions of general practitioners for the modification of the parameter for the identification of the offices, proposing the solution of one doctor for every 1,200 inhabitants, from apply only in areas with over 16,000 inhabitants, but today this solution has not met the favor of all the trade unions and, despite an initial agreement, yesterday during the last meeting some representatives did not sign the agreement».

«If we want to respond to current needs, we need everyone's commitment. With a view to reorganizing local healthcare, we have foreseen the allocation of 3 million per year for the activation of the Continuity of Care Units in the three-year period 2023-2025 , which will participate in supporting the activities of general practitioners, and 50 million in three-year period 2023-2025 to be invested in the Single Role of General Medicine with a cycle of choices and an hourly cycle after rapid trade union negotiation of the new regional supplementary agreement (AIR) which represents the tool with which to incentivize healthcare personnel to redesign the new territorial healthcare including the current continuity of assistance which must represent a safe territorial filter for all those pathologies that can be classified in the green and white codes that today invade our emergency rooms », concludes the commissioner.

(Unioneonline/ss)