Italy’s primary care Reform: A battle Over Doctors’ Roles and the Future of Healthcare
The Italian healthcare system is at a crossroads as debates over the reform of general practitioners’ roles intensify. Within just 48 hours, two competing proposals have emerged from government-aligned circles, sparking widespread discontent among doctors and raising critical questions about the future of primary care in the country.
The first proposal, championed by Forza Italia, suggests that general practitioners dedicate 20 hours per week to their patients and 18 hours to community houses—social-health hubs funded by the PNRR (National Recovery and resilience Plan) and designed to enhance primary care.Under this plan, doctors would retain their status as self-employed workers affiliated with the National Health Service (NHS).
The second proposal, revealed by journalist milena gabanelli in Corriere della Sera, aligns with Health Minister Orazio Schillaci’s vision. It mirrors the hourly distribution but shifts doctors to direct employment under the NHS, placing them on par with hospital staff.
Both proposals have opened a Pandora’s box of questions. pina Ononri,secretary of the Italian Medici Union,voices concerns: “Are they asking us to contract the assistance activity towards our patients? Seriously,it is believed that our care load,especially in the Post-Covid era,can be compressed into 20 hours a week?” A survey of hundreds of union members revealed that 97% disapprove of the Forza Italia reform.
Ornella Mancin, a general practitioner in venice, calls the proposal “inadmissible,” questioning why doctors should work 38 structured hours while bearing the costs of managing their practices and forfeiting benefits like holidays and sick leave. Andrea Filippi,secretary of FP CGIL,criticizes the plan as creating “contractual hybrids that worsen the current association of territorial assistance.”
The CGIL union supports transitioning doctors to public employment, proposing a specialization school to replace regional training courses. This shift could initially apply only to new hires, aligning with government intentions. Though, Filippi warns, “Its a film we’ve already seen. Minister Speranza had also proposed public dependence, and corporate interests prevailed.”
At stake is not just the framework of a profession but the future of community houses, which must be fully operational by 2026.these facilities, managed by family doctors, represent a critical opportunity to revitalize Italian healthcare. Yet, negotiations are fraught with challenges.
Filippo Anelli, president of the Italian Medical Association and former leader of the Fimmg union, opposes the dependency model. The financial implications are important: ENPAM, Italy’s largest private pension fund with assets of nearly €26 billion, could face collapse if doctors transition to public employment. Silvestro Scotti, national secretary of Fimmg, warns of “mass resignations” as nearly 10,000 doctors are already eligible for retirement.
Not all doctors prioritize these concerns. Laura Viotto, a family doctor in Rome, argues that “bottega interests” are blocking reform. She authored a document signed by dozens of doctors advocating for NHS integration, stating, “It is clear that without a reform, territorial health is banging.”
| Key Proposals | Forza Italia Plan | Schillaci Proposal |
|——————–|———————–|————————|
| Hours per Week | 20 (patients) + 18 (community houses) | Similar distribution |
| Employment Status | self-employed, NHS-affiliated | Direct NHS employment |
| Support | Limited, with 97% disapproval among surveyed doctors | Aligns with CGIL’s push for public dependence |
The debate underscores the complexity of reforming Italy’s primary care system. As doctors, unions, and policymakers clash, the clock ticks toward 2026—a deadline that could determine the fate of Italian healthcare. Will the reform succeed, or will it fall victim to competing interests? The answer lies in the hands of those shaping the future of community houses and the doctors who will run them.
Italy’s Primary Care Reform: A Battle Over Doctors’ Roles adn the Future of healthcare
Table of Contents
The Italian healthcare system is at a crossroads as debates over the reform of general practitioners’ roles intensify. Within just 48 hours, two competing proposals have emerged from government-aligned circles, sparking widespread discontent among doctors and raising critical questions about the future of primary care in the country.
The Competing Proposals
Senior Editor: dr. Marco Rossi, thank you for joining us today.Let’s start with the two main proposals on the table. Could you explain the key differences between the Forza Italia plan and the Schillaci proposal?
Dr. Marco Rossi: Certainly. The forza Italia plan suggests that general practitioners dedicate 20 hours per week to their patients and 18 hours to community houses—social-health hubs funded by the PNRR (National Recovery and Resilience Plan). Under this plan,doctors would retain their status as self-employed workers affiliated with the National Health Service (NHS).
On the othre hand, the Schillaci proposal, as revealed by journalist Milena Gabanelli in Corriere della Sera, mirrors the hourly distribution but shifts doctors to direct employment under the NHS, placing them on par with hospital staff.
Doctors’ Reactions and Concerns
Senior Editor: What has been the reaction from the medical community to these proposals?
Dr. Marco Rossi: The reaction has been largely negative,especially toward the Forza Italia plan. A survey of hundreds of union members revealed that 97% disapprove of it. Pina Ononri, secretary of the Italian Medici Union, voiced concerns about compressing care load into 20 hours a week, especially in the post-Covid era.
Ornella Mancin, a general practitioner in Venice, called the proposal “inadmissible,” questioning why doctors should work 38 structured hours while bearing the costs of managing their practices and forfeiting benefits like holidays and sick leave.
The Future of Community Houses
senior Editor: The reform also involves the establishment of community houses, which must be fully operational by 2026.What role do these facilities play in the future of Italian healthcare?
Dr. Marco Rossi: Community houses are designed to enhance primary care by providing social-health hubs managed by family doctors. They represent a critical opportunity to revitalize Italian healthcare. However, the success of these facilities depends heavily on the outcome of the current reform debates.
Financial Implications and Union Support
Senior Editor: What are the financial implications of transitioning doctors to public employment, and how do unions view this shift?
Dr. Marco Rossi: Transitioning doctors to public employment could have significant financial implications. ENPAM,Italy’s largest private pension fund with assets of nearly €26 billion,could face collapse if doctors move to public employment. Silvestro Scotti, national secretary of Fimmg, warns of “mass resignations” as nearly 10,000 doctors are already eligible for retirement.
The CGIL union supports this transition,proposing a specialization school to replace regional training courses. However, Andrea Filippi, secretary of FP CGIL, criticizes the plan as creating “contractual hybrids that worsen the current association of territorial assistance.”
The Path forward
Senior Editor: With such polarized views, what do you see as the path forward for Italy’s primary care reform?
Dr. Marco Rossi: The path forward is fraught with challenges. The debate underscores the complexity of reforming Italy’s primary care system. As doctors, unions, and policymakers clash, the clock ticks toward 2026—a deadline that could determine the fate of Italian healthcare. The answer lies in the hands of those shaping the future of community houses and the doctors who will run them.
Senior Editor: Thank you, Dr. Rossi, for your insightful analysis on this critical issue. It’s clear that the stakes are high, and the outcome of this reform will have a profound impact on the future of healthcare in Italy.
dr.Marco Rossi: Thank you for having me. It’s a pivotal moment for Italian healthcare, and I hope that a balanced solution can be found that benefits both doctors and patients alike.
