Monday, October 18

Health considers the COVID emergency over and urges communities to rebuild Primary Care

Beyond what the daily data confirm, Spain is beginning to make gestures that show that the country is finally coming out of the pandemic. The Minister of Health, Carolina Darias, meets in person this week with all the health advisers of the autonomous communities. He has summoned them to two days of meeting in the Canary Islands with the aim of starting the reconstruction of the health system. The authorities want to start at the base: Primary Care, the most devastated link in the last year and a half. Two medical congresses, one in Zaragoza and the other in Palma, are also exploring these days, with conferences and round tables, the day after for the public system.

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Primary Care professionals are “exhausted”, “in an agonizing situation”, “demobilized”, “active”. This is said by several doctors with whom has spoken about their expectations of the meeting between Health and the autonomous communities, from which a photo of unity between authorities will foreseeably come out at the end of the pandemic. “We cannot continue to say that we are the gateway to the system, that we function well, that it is the best we have, because we die. At some point we have to hit rock bottom to resurface and we are close to reaching that point,” he says. Rosa Magallón, family doctor in Zaragoza and president of the Spanish Primary Care Network.

Along with other doctors, Magallón has promoted a manifesto to “save” the public service that is provided in health centers. The document certifies that the “excess activity in the pandemic” has exacerbated “old problems”. The pandemic has exacerbated difficulties dragged on for more than a decade, such as under-endowment of resources, but it has also created new fears. For example, that the interposed activity (telephone appointments, telemedicine, electronic mail …) is imposed on the face-to-face and that “has dire consequences for the poorest and oldest population,” the professionals warn in the manifesto. “Not to mention the diagnostic and specialized delay that has occurred in this year and a half,” adds the doctor.

In the sector they are annoyed with the governments of the autonomous communities, which are in charge of the health systems, but also with the Government of Spain. The Recovery, Transformation and Resilience Plan does not include any specific investment for Primary Care, despite the fact that one of the strategic lines is “to strengthen Primary and Community Care.”

Spain has faced the pandemic with health centers in the chassis. The Recovery Plan itself underlines this. “Even before the COVID-19 pandemic, the system already had significant weaknesses. Many of them have also been highlighted in the comprehensive country reports issued by the European Commission in the framework of the European semester, […] such as the recommendation to strengthen Primary Care “.

The items that communities spend on health centers did not recover until 2019 since the 2008 crisis, 11 years later, according to the latest consolidated accounts of the National Health System. That year, real spending was 9,874 million euros compared to 9,317 in 2009, just 15% of the total invested in health by the autonomous regions. Andalusia and Madrid are at the tail of spending per inhabitant; Euskadi, in the lead. The most recent statistics on health from the OECD, with data from 2017, confirm that health spending per capita in Spain (2,371 euros) is 15% lower than the average for the European Union (2,884 euros).

The president of the Spanish Society of General and Family Physicians (SEMG), Antonio Fernández, asks “a sufficient budget, articulate sufficient human, technical and technological means and resources to maintain the system.” “If we want something else, let’s decide, but let’s not continue deceiving people,” says this family doctor with 40 years of experience in a town in Toledo.

Fernández and Magallón agree that the pandemic has revealed more than ever the “precariousness” of Primary Care. “But the coronavirus has also shown that they have abandoned us because they have preferred to implement striking measures such as mounting large ‘ifemas’ instead of reinforcing. We did not have telephone lines available, but we did have large tents in front of the hospitals,” criticizes the doctor Zaragoza.

“By losing we have lost even the image we had in the face of society. It seemed that we were not involved or it was even said that we were closed. That is unfair. Primary Care has stood up and has stopped 90% of all the pandemic. It has prevented hospitals from collapsing, “claims the president of SEMG, who laments the” decapitalization of the system. ” He tells that he is the only doctor at his health center (in Gálvez) since the beginning of the summer.

Medical societies warn that it is the last opportunity to put resources in health centers. “In the coming years many colleagues are going to retire. There is no change”, indicates Lourdes Martínez, a family doctor in the Ensanche de Vallecas (Madrid) and one of the speakers at the first round table of the SEMERGEN Congress that begins this Wednesday. The title is: Primary Care in Reconstruction. The health center staff have another appointment this week in Palma (Mallorca) with the XLI Congress of SEMFYC. There they will talk, among other things, of “community health in times of COVID-19”.

The Forum of Primary Care Physicians estimated the deficit of family medicine at 2,700 positions in 2018. Lack of planning, cuts and poor working conditions have been depleting the workforce. But it is not only a problem of lack of staff. “We have to recover the essence of PC: knowledge of the patient, time to care for their chronic problems, recovering the always battered community care, education for self-care … gradually recovering face-to-face. Only by looking and touching can a diagnosis be made, “Magallón demands. Martínez shares it.” We spend a lot of time on the demand consultation. That must be done, but the other – prevention, meetings with patients and health education – is not being possible. We don’t just treat the disease. ”

The narrowness of the pandemic has exacerbated, add several of the doctors consulted, the “hospital-centered vision.” “Even for the citizens,” Martínez emphasizes. “All the spending goes to the hospitals. There are very good and very expensive treatments in the hospital, but most people do not need that. We aspire to a structural change. Spain is not the same as in the 70s when this model was designed: we have older patients, an older population and technologies that would speed up tests and diagnoses to which we do not have access, “he concludes.

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