Primary care: promise and sign agreements until you vote and then...

It rains on the wet, it threatens to continue doing so intermittently until the end of May, and the storm could worsen -and a lot- after the regional elections of 28M, if the will of the political leaders who arrive -or who remain- in each of the autonomous communities.

This is, broadly speaking, the feeling of health professionals who work in primary care that has been shaken by a permanent upheaval in recent months.

To the communities that continue with a

, we add the health services that, since last November and almost consecutively, have signed agreements to call off the strike.

The general feeling of the professional unions that called these mobilizations is that the agreements signed are just that,

,

The conviction of the rest of the unions (fundamentally, CCOO, UGT and CSIF), and of many toilets that work in these communities, is that not even what has been signed is valid and, in fact, these unions have already announced mobilizations and strikes in their autonomous regions. .

"We are exactly at

not be deceived: the councilors have sat down to negotiate because they have a very short date in mind term, that of 28M. Once the electoral commitments have passed, the regional governments will implement their respective political agendas and will put away

, call them electoral promises or even signed agreements".

The diagnosis, which does not bode well for the solidity of what has been signed these days in the autonomous communities of Murcia, Cantabria, Extremadura, Aragon, Andalusia and Catalonia, is made by

, National Secretary of Primary Care of the State Confederation of Medical Unions (CESM), the union that called for all the regional strikes and the majority among doctors.

The panorama that draws a brief tour of these autonomies is not much rosier.

Cantabria

On November 17, the Cantabrian community was the first to exhibit the

of the agreement with the Cantabria Medical Union (SMC), which had mobilized the bulk of the Family doctors and primary pediatricians of the community chaired by

.

Barely a month and a half later, on January 21, the first monitoring commission of that agreement produced, in the form of a statement, the following union balance: "Shame of

. "

The executive committee of the SMC thus summarized the "manifest non-compliance" in key issues such as

, the stabilization of employment, the creation of a bag of continuity doctors or the establishment of

to prevent attacks on health professionals.

"Unfortunately, we are veterans of non-compliance, and I refer only to the most recent, the 2019 agreement, which has ended up causing the 2022 strike. If you ask me about my feeling, I will summarize it easily: you are not going to comply with anything until

and, from there, we'll see," says

, general secretary of the SMC.

Now, Alonso is very clear about how that "from there" is going to develop, at least from the trade union point of view.

"The measures are not only signed, but also published in the Official Gazette of Cantabria (BOC), and the doctors are not going to allow them not to comply with them. The 2019 agreements became a dead letter because the pandemic arrived and the doctors, giving example, once again, of their innate responsibility, they focused on the most urgent thing, which was Covid, but now

.

Unfortunately, we are veterans of breaches by the Administration

Vicente Alonso, General Secretary of the Cantabria Medical Union

Alonso ratifies that today, more than two weeks after that first monitoring commission of the agreement, the essentials are still not fulfilled: "The design of the agendas and the organization of work to comply with the agreed limitation of the Family Medicine agendas [a maximum of 35 patients] has not yet been developed in most health centers; the security cameras that they promised to place immediately ensure that they are in a situation of "administrative tender" and, at this rate, they are They will place, hopefully as of May or June;

... add up and continue".

Piano piano si arriva lontano,

the Cantabrian Health Minister,

, must have been thinking when he announced compliance with one of the points of the agreement a few days ago: "The Cantabrian Health Service has incorporated ten Family doctors since February 1 in the health centers with the most saturated schedules and the longest delays.The objective is to keep the quotas below 1,500 patients, to guarantee

". Regarding the organization of the agendas that Alonso demands, the counselor has qualified that the centers in which these new professionals have been incorporated are "in the middle of the process of reassigning the quotas that correspond to each doctor, a procedure that is It will still take a few days". The SMC recalls, however, that

.

A woman protests with a sign that reads 'The first thing, the primary' during a concentration of primary doctors and pediatricians in the center of Madrid, on February 15. Alejandro Martínez Vélez / EP

Regardless of the strength of what has been signed or its current degree of compliance, what the SMC general secretary is clear about is that Cantabria, like the rest of the communities that have reached agreements, has benefited from the Madrid

:

, like

, he sums up.

Along the same lines, the CESM National Secretary for Primary Education affirms that the strike in Madrid "generated a kind of panic in the rest of the ministries, and some of them have rushed to sign agreements before the appointment with the polls, but Good predisposition is useless if it is diluted after the elections".

Region of Murcia

Much more satisfied than the Cantabria Medical Union seems its namesake in the Region of Murcia with compliance with what was signed in that autonomous community, the second that reached an agreement, also in November 2022. The key to that satisfaction is, according to

, president of CESM-Murcia and finance secretary of the union at the national level, that "

and has had, before and after the signing, a clear will to address them."

The Ministry-CESM agreement, which was later ratified at the Murcia Health sector table, includes the creation of

, the incorporation of 9 midwives, 30 Nursing professionals, 11 physiotherapists, 11 social workers, 11 Nursing assistants and another 18 administrative assistants, in addition to the well-known limitation of care schedules (a common claim in all communities), which, In the case of Murcia, it has been set at 30 daily appointments for Family and 20 appointments for pediatricians, in addition to limiting the number of appointments considered "non-delayable" to five.

Campillo assures that CESM-Murcia follows "very closely" the evolution of what has been signed and that, at least for the moment,

.

"We are in the middle of the process of allocating the necessary resources and tools to address care delays, because the ultimate goal, let's not forget, is to provide the best possible care to patients. The agreement not only articulates afternoon modules, but also that contemplates the increase in staff, and this point is vital".

The balance that the Executive Committee of CESM-Murcia makes of the monitoring of the agreement, which was signed on November 25 (and to which CSIF and Satse have adhered), differs significantly from that made by their colleagues in Cantabria.

Among other things, the professional union assures, the Primary Care coordinators in the region already have effective recognition as heads of service, the remuneration of the afternoon modules in primary care

and the so-called

and, since last 1 January, professionals who practice in areas and positions that are difficult to cover receive the economic incentives agreed for these areas.

The president of CESM-Murcia agrees with Alonso and Giménez that "

, but I insist that, in the case of our community, the joint will to find a way out has prevailed, Proof of this is that the agreement signed includes aspects such as an increase in staff and the search for solutions for areas that are difficult to cover".

In Murcia,

, the CCOO and the UGT, and they extend it to the entire sphere of the Civil Service, since the objective of both formations is to "reverse the cuts that, since 2010, suffer public employees in the region" and extend to all civil servants, including health personnel, measures such as

, the classification of all professional categories and early partial retirement.

Aragon

The same discontent, and with almost the same protagonists (CCOO, UGT and CSIF), is palpable in

, where these three unions have called a joint strike for March 31, and they have done so barely 15 days after the The Ministry of Health and the professional unions of the community (CESM-Aragón and Fasamet) sign an agreement to improve primary education that, from what has been seen, does not guarantee social peace.

, both for its content and for the fact that the

council has signed it only with the two professional unions.

"This is not an ordeal, it is not a threat. We can't take it anymore and they have left us no other option," said

, general secretary of the CCOO Health Federation in Aragon, in the joint call in which the three unions announced the call for strikes.

According to

, from CSIF Aragón, the last straw of her discontent has been the bilateral negotiation that the Repollés department has maintained only with the doctors.

Regarding the content of the primary agreement, signed in Aragon on January 18 and which, according to the council, will cost the regional government about 8 million euros a year, the three class unions argue that it only offers concrete improvements

, and they demand that all the health centers in the region open until 8:00 p.m., since "the agendas are collapsed, the centers are saturated and in the afternoon emergencies the professionals cannot cope."

To their demands for primary, the strike of March 31 adds other requests for toilets in general: the 35-hour day, the unlocking of the career (paralyzed since 2011), the redistribution of functions and professional reclassification, among others.

One of the supporters of this agreement "only for doctors",

, president of the Fasamet union, frames the discomfort of the rest of the unions in another electoral context, in this case, the union.

"Here, on March 30 [just one day before the date chosen by the CCOO, UGT and CSIF for their strike call]

and everyone has to play their cards.

I understand that everyone wants to get the greatest possible benefits for their affiliates, but I do not agree that ours is an exclusive agreement.

It is evident that we, the medical unions, look after the conditions of the doctors, but the improvement in primary care that this agreement contemplates is a general improvement for the level". Catalán also assures that many of the demands that beat after the strike March are also shared by CESM and Fasamet.

The viability of the agreement depends on a change of mentality, starting with the doctor

Leandro Catalán, president of the Fasamet union

Regarding the content of what was signed on January 18, the president of Fasamet points out that the agreement does not officially enter into force until March 1.

Among other measures,

Of these 35 patients, 28 would be face-to-face and 5 of them urgent and/or immoral (the citation for these consultations must be made the same day and through the center's admission services).

The rest of the appointments, up to the limit of 35, would be managed by the doctor (scheduled, telephone and administrative).

In the case of Pediatrics, the schedule is limited to 28 patients (24 face-to-face, non-face-to-face and immoral and/or urgent).

Catalan points out that

, among the patients, but also among the health professionals themselves.

"One of the main questions that has arisen is what will happen to patient 36 [or 29, in the case of Pediatrics], but the agreement establishes very specific guidelines to attend to the so-called overflow consultations, with

days Afternoon hours of two or four hours, depending on the case, and also a limited number of patients. However, this implies, first of all, that the

.

Beyond the declarations of good intentions, the president of Fasamet admits that neither the Aragon agreement nor those that have been signed in other autonomous communities close, in his opinion, the open conflict in the first care level, but "it is evident that professionals at this level, and especially doctors, are

in all health services, and immediate measures had to be taken. The next step is, obviously, to ensure compliance with what was signed, and there, in Aragon, We are going to be very vigilant, of course."

Andalusia

More controversial if possible is the situation in

.

The Government of

, represented by her Health Minister,

, signed on January 27 a bilateral agreement with the Andalusian Medical Union (SMA) for the improvement of primary care that deactivated the strike called by the professional union.

In theory, this agreement must now be ratified by the Andalusian Health Sector Board, but the rest of the unions that make up that negotiating body, far from wanting to sign anything, are immersed in a campaign of mobilizations (weekly protest rallies in health centers throughout the region) to show their rejection of the bilateral document.

CCOO, UGT and CSIF agree with their colleagues from Aragon in criticizing that the Ministry has only negotiated with doctors and in questioning the content of an agreement that, according to them, is only a "patch" for the level.

A few days ago, García's department convened

and the three class unions missed the same thing: "concrete measures" from the Andalusian Health Service (SAS), such as the reinforcement of templates, technical means and "decongestion and debureaucratization" of primary care.

In a joint statement, the three unions ensure that the SAS limited itself to putting "very general and diffuse proposals" on the table, such as the resolute improvement of primary care, the adaptation of agendas and quotas, training, research, positions that are difficult to cover , tutoring or new professional categories.

In short,

which, according to the unions, are "disappointing and insufficient and do not take into account all the professional resources of all the categories that we have in Andalusia, nor other new ones that are still not there".

"We demand from the Andalusian Executive and the SAS a true negotiation on primary, not separate agreements with a union that represents only one sector, but a true table to reach an agreement that includes a change of model, labor and remuneration improvements and sufficient investment to have the level we need", says

, spokesman for the Federation of Health and Socio-Health Sectors of the CCOO of Andalusia.

The CCOO, UGT and CSIF also agree that the only concrete measures already announced by the Ministry of Health, and which constitute precisely the axis of the agreement signed with the SMA, consist of reducing tomorrow's agendas in Family Medicine and Primary Pediatrics and in enabling afternoon consultations to guarantee continuity of care, "they will not solve professional overload at all, nor do we believe that they will serve to reduce delays in appointments".

has maintained since January 20,

which has no representation on the sectoral table. , has few affiliates and, as they themselves admit, has not managed to actively mobilize many doctors, but has emerged as one of the most critical voices with the bilateral agreement signed between the Ministry of Health and the Medical Union.

Carmen González Uceda

, president of the SMP, argues -and extends her criticism of the agreements signed in other communities- that "33, 34, 35 or 36 patients a day, which are the care limits that CESM is signing in the communities, do not solve, not even remotely, the overload of the level".

The president of the SMP estimates that

, without counting the due breaks.

With that number of patients, in addition to missing many days of time to attend to all of them, where is the training, where is the teaching and research;

What time would we have for essential Family Medicine activities such as prevention or community activities.

I tell you:

.

So I don't know what deals

."

Catalan doctors throw their gowns to the ground in a symbolic act of protest during one of the demonstrations called in Barcelona.METGES DE CATALUNYA.

In addition to questioning that those ten minutes per consultation are the minimum time necessary to care for a patient well, an idea that seems to have already become an axiom, González Uceda criticizes the perpetuation of "discrimination" between care for children and adolescents on the one hand and adults and the elderly on the other.

? It is true that most of the consultations for children are clinics, but a substantial part are also acute infectious processes, while that adults and the elderly tend to consult for various processes at each appointment in greater numbers than children, processes that, in addition, tend to be more complex the older they are",

The president of the SMP leaves another question in the air that, based on previous experience, is difficult to answer:

?

"The Health Departments have very tight budgets and it is very, very difficult for them to be revised upwards. However, more staff, more material resources and better salaries, which are the axes of the historical demands for primary care, necessarily imply more budget and the agreements that have been closed in the communities do not specifically talk about budget increases, except, as far as I remember, the one in Aragón, which talks about increasing it up to 25% in the next 4 years".

To what extent the governments that come out of the polls will assume the commitments signed

Ana Giménez, National President of Primary Care at CESM

The one of Aragón and the one of Catalonia, qualifies the national president of Primary of CESM, but adds that these commitments of budgetary increase are not immediate nor in the short term, but that "its theoretical fulfillment is delayed in a period of several years and transcends, therefore, the horizon of the current legislature, which already has little left. We are, then, in the same:

. We'll see, "says Giménez.

According to the person in charge of CESM, "traditionally, the central and regional administrations are dedicated to playing ping

with each other, evading their respective commitments and, together, they will end up killing primary care in this country."

Catalonia

The agreement signed on January 31 between the Doctors of Catalonia union (MC) and the Catalan Health Service has only materialized, for the moment, in the creation of a tripartite working group (union, Administration and Council of

of Doctors of Catalonia) to "favor dialogue with the medical community and continue working on organizational issues that can improve healthcare for the public".

That says, at least, the signed document.

In line with the

game referred to by the CESM Primary School president, but in this case between the regional administrations themselves, the Catalan Minister of Health,

, assures that the strike "has channeled a malaise that does not come from three months, which is the time that we have been in the department, but that comes from afar: from the 2010 cuts, from the pandemic and from underfunding. From a set of causes, in short".

The fact is that the Administration recalls that the organizational, remuneration and labor measures agreed with Metges will have to be transferred later to the pertinent negotiating tables "to be addressed with all the actors involved: employers and unions".

In such a way that the need for everyone to agree on the negotiation is then added to that work table.

.

Some hint of how ambitious and lengthy the measures included in the Catalan agreement are for such a short time horizon until the next appointment with the polls:

;

enhance the autonomy of health professionals, reserving 4 hours a week for the development of clinical tasks without a patient, limit the volume of telephone appointments at health centers or reduce bureaucratization.

Quite a desideratum.

Galicia

In

, the strike, at least for now, does not knock on the doors of the Galician Health Service (Sergas), but last Sunday the SOS Sanidade Pública platform called a demonstration in protest "for the situation of the health system."

In the case of the Galician primary -and perhaps because of

...-, the Ministry of Health anticipated a possible discomfort of the doctors with the announcement, at a sector table, of a series of improvement measures for the first level.

These measures, which just a day later were announced to great fanfare in the Galician Parliament, include the call for

unopposed for places with difficult coverage in health centers and regional hospitals, as well as 3-year contracts for residents who finish the MIR in the specialty of Family Medicine.

Specifically, the promised 400 places would be offered by merit competition to Family doctors, primary pediatricians, specialties (yet to be specified) in regional hospitals and Mental Health, and would be added, according to ministry sources, to the 106 places that they were offered in 2022 through the same procedure in compliance with the workforce stabilization law.

To the creation of these new positions, the Sergas adds the commitment (for the moment, only verbal) to arbitrate measures so that the care schedules of the doctors do not exceed 33

, "in compliance with the scale that the Galician Government has established". and, in the event of having to extend the working day due to demand peaks, being able to do so in exchange for "additional remuneration".

The one that certainly does not seem very happy with the measures announced by the Xunta is the Galician Association for the Defense of Public Health, which yesterday described them as "hasty and desperate", and sees in them an attempt to counteract professional support for the demonstration of January 12 in Santiago.

Among other things, the Association argues that the awarding of owned places without examination is

that "blatantly" violates the principles of equality, merit and capacity that regulate access to public employment.

It also states that the announcement of the creation of these 400 positions contradicts the argument put forward by the Ministry of Health that there are no doctors to hire, and that "offering a bonus to expand the activity of professionals subjected to overwhelming healthcare pressure would mean a risk to the population, by increasing the possibility of medical errors".

Canary Islands

In the

, the recent strike of temporary doctors is added to the primary malaise, and trying to get ahead of all this, the director of the Canary Islands Health Service (SCS), Elizabeth Hernández,

an organizational model to the autonomous scientific societies last week " to reduce the assistance pressure and the delay in the primary", which, in theory, will come into force on March 1, three months before the elections.

Among other things, this new model contemplates

of 34 patients per day for Family consultations and 28 for pediatrics, "as well as the possibility of establishing replacement schedules to reduce delays and efficiency measures that facilitate this assistance." according to the person in charge of the SCS.

STRUCTURAL SOLUTIONS

Beyond the discontent of the regional unions that have been left out of the agreements signed these days in several autonomous communities and the reluctance expressed even by the unions that signed these agreements, the truth is that all the professionals agree that the first level will not be

with specific solutions, also urgently needed by the electoral calendar, but with structural measures, which are precisely those that are conspicuous by their absence.

"The paradigm of healthcare needs of the population has changed a lot, but so has the concept of professional vocation and the relationship between it and remuneration and workloads. In a context of globalization, professionals go to work where they best fit treats them, in such a way that the organizational structures, job offers and the care approach that perhaps worked 20 years ago, now does not respond to the new needs," says Ana Giménez, president of Primary Care at CESM.

She emphasizes, for example, the planning approach of some regional administrations: "

.

As long as the communities are not aware that we need job offers capable of retaining the people we train and attracting more professionals, nothing will change."

And if these structural needs are not addressed, the primary school improvement agreements, no matter how much they are signed in cascades in several autonomies, will be mere false closings of the crisis, and someone who has recently signed one says so, the general secretary of the Medical Union of Cantabria, Vicente Alonso: "The indications about the will to comply with our politicians are not very encouraging. I do

in our community and in many others, whether or not they have signed agreements these days.

The regional elections can mark a before and after, but it is not necessary to wait for the polls to see if what has been signed is fulfilled or not, and that is why monitoring commissions were invented," concludes Alonso.

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