"If we do not solve and redirect the problems we have, we will lose primary care and the health system will worsen"

He has held countless positions, from a sub-directorate in the Ministry of Health, through the presidency of the National Commission of Family and Community Medicine, guarantor of the MIR formation, to succumbing to the political adventure of directing the Ministry of Health in Castilla y León. But Verónica Casado is above all a family doctor, vocation and practice that earned her to be chosen as the best in the world in 2018.

He knows like no one else the reality that the primary care of the p system lives

Public Health and its professionals. Today, from the center of Valladolid where he practices, he defends the role played by professionals of the first level of care, "fundamental axis for the system to work" and recalls that

, has been warned for many years.

Why are family doctors so demanded by neighboring countries?

That has been going on for years. When she was still president of the National Commission of Family Medicine and the congresses of the Spanish Society of Family and Community Medicine were held, Semfyc, United Kingdom or the Ministry of Sweden asked to have a

to be able to attract residents in Spain and then go there.

, while here we value little what we have. Together we are letting this be spoiling us.

How has this lack of family doctors been reached?

In addition to the Covid pandemic, which has strained the health system and especially one of the most important elements such as primary care that had already been touched, the turning point has been the shortage of doctors. Already

. In that study, published in 2007 and that reached this decade, it was already said that if nothing was done there would be a series of specialties that were going to be in surplus, others balanced and others in deficit. And there are two that are the most stressed, Family Medicine and Pediatrics, both primary care.

After that work there have been five more editions and the same thing has always been said.

As president of the National Commission of the specialty, in charge of proposing the appropriate number of MIR places, what did you propose?

In 2014,

MIR for Family Medicine; It was not a random number and responded to the studies we had done on the replacement of doctors, because retirements are a variable that is there. It is not a meteorite that suddenly falls. We already knew that we belonged to a cohort of professionals who were going to retire in these years and we had to take action. Well, they gave us 1,600 telling us that we were not interested in the faculties of Medicine or the autonomous communities. From this situation of systematic non-redirection of the needs of family specialists, we are now faced with a very important problem. And it happens that in a health center where there should be 16 doctors six are missing and everything is stressed. And it is angry, because in 2015, when the WHO published the Observatory of primary care, where based on 115 indicators of process and structure results in 31 countries, Spain was always among the top three positions.

And what has happened?

I wonder what has happened so that we are not able to identify the strength of this primary care. When you go abroad, they talk about the National Transplant Organization, the MIR training system and primary care. But

A primary with the three characteristics, longitudinality [stable relationship between doctor and patient], accessibility and globality, directly impacts a better level of self-perceived health and fewer hospital admissions. Improves life expectancy; This was an evidence.

We have a very important problem in this country, which is the short-termism of health policy.

What have been the threats or weaknesses that have prevented identifying the importance of primary?

Since

. Family doctors are full of bureaucratic procedures within our consultations, such as the processing of thousands of casualties, and that represent between 30% and 50% of the task. These tasks are of the health administrators. That is a problem of internal organization.

And then there is a management problem related to the wrong decision to create the single managements instead of a specific one for primary care that solves the problems.

In short

. If you add to all this that in some communities there may be some bankruptcy of the public model and the tendency to look for alternative forms causes important problems to be generated. It must be very clear that comparative studies on national health systems affirm that those whose strategic axis is primary care make an investment in health.

Do you think there is a problem of prestige in primary care?

Yes. If you do a transplant, it has light and stenographers and gives it a lot of visibility, but

. Nobody knows the effort we make to get someone to stop smoking, to control their diabetes, their hypertension, to exercise... All that is not seen, not prejudiced, not talked about. If we lose the clinical preventive medicine that is done in primary school there will be an impact on life and health.

Do you think the public health system as we know it is in danger if it is not reinforced primary?

The World Bank says it, where cold data is analyzed: if you have a resolutive primary care you will have a much better secondary and tertiary care. If we are not able to solve the problems we have and redirect them, we will lose primary care and worsen the health system. An alternative will probably emerge, but it's not going to be any better than this; it will be something else. But

We have not been able to see that the strength of the first level of care translates into lives

There is a lack of family doctors, some go abroad to work and others are going to retire in the coming years and it takes time, years, to have a new 'batch' of these specialists. Is there a more immediate solution to reinforce primary at least in human resources?

The first thing is to set up primary care teams well.

. You need them to be trained, because it is a legal mandate and you cannot hire people from outside without them being approved or graduates in Medicine. So

. Meanwhile we must begin to reorganize the planning of human resources and do so by taking out the MIR training places in those specialties that are at risk and that the health system needs and do it by autonomous communities. This is something we have been saying for many, many years.

This has to be capitalized and can never be short-term. What we do is political short-termism because every two or every four years there are elections and everything stops. And I have seen it clearly after my political experience. Large projects take four and eight years to consolidate. As long as we do not make a great political pact for health we will have a big problem because health is always going to be used as a weapon against each other.

It seems that only in these pre-election times is when politicians worry about what happens in the public health system.

Yes, but they worry in a weird and bad way; facing the gallery. The moment of more union that I lived as Minister of Health of Castilla y León was at the beginning of the Covid pandemic, in the months of March and April 2020. In the Interterritorial Council of the National Health System we were people dedicated body and soul to saving lives; There were neither right nor left there. But time began to pass and everything became politicized and annoyed. We have a problem of the legal framework of public health and nobody prevents us from having another pandemic.