The primary care reform. The “dream book” is law

by Ornella Mancin


Dear Director,
the reform of territorial medicine is law. In fact, the now infamous DM 71 (actually DM 77) was published yesterday in the official gazette of its original system, with no significant changes in profits at least at first reading.

Despite the attempt by some (to tell the truth) to highlight the problems (many), in the silence of those who should and could have intervened and in a completely “inevitable” way, the reform process that will dictate the structure of territorial assistance in the coming years.

It is not known how the various handed out items will be rejected, and although one can imagine that it will be enough to have money available to build communal houses and buy the equipment (ultrasound scanners, electrocardiographs, spirometers and so on), it is very difficult to understand with what staff will “fill” such houses.

The lack of staff, first and foremost doctors, is bringing our NHS to its knees already now: there are countless family doctors for retirement and dropouts (only in Veneto more than 500), specialists leaving hospitals en masse and ahead of a project that apparently ignores reality: doctors available 12 hours a day 7 days a week, specialists working in community centers (when they are already unable to guarantee hospital visits), nurses available 7 days a week, social workers, psychologists to a number respectable goals.

And again: prevention and protection of health, taking over chronic diseases and fragility, ensuring continuity of assistance also through coordination with local health services, activation of interdisciplinary paths, involvement of communities and citizens.

All while maintaining a high standard of assistance that must be “rejected in its various dimensions (eg appropriateness, security, coordination / continuity, efficiency, timeliness)”.

Not to mention the planned incentive for home care because “the home is identified as the first place of care, as a privileged setting for local care”.

I do not know if it just sounds like a good dream book to me. Today, we struggle to complete exams with priority, our queries “flow” on lists that we do not know when they will be examined, and people end up turning more and more to the private sector; finding a place in a local hospital is a chimera, and home care struggles with difficulties due to lack of strength …; who knows why I doubt that this reform will not solve all this and that it will end up remaining on paper, as has often happened in the past.

Maybe that’s exactly why the unions have not cared so much about it … they trust the Italian “everything changes so nothing changes”.

After all, these days dr. Belleri enlightened us in one of his speeches (sp. June 22) with a brief summary in 5 points, how the fate of the family doctor was and is inevitable and his end largely predictable given the socio-cultural changes (increase in specializations, techno -scientific development, web-diffusion …), which one obviously could not do anything about.

No responsibility therefore from those who ruled and ruled the profession, no guilt to be attributed to the unions … what can be done against the fate that has raged against our profession? We are designated victims of an evil world that wants us to disappear.

Hard to believe, it would mean acknowledging that our unions never contact anything and we have maintained a device just for fun.

Ornella MancinPhysician in general medicine

June 24, 2022
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