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Primary: from hope to anger


Serafin Romero

President of the Collegiate Medical Organization (WTO)

Coinciding with the 40th anniversary of the Spanish Constitution, which perfectly preserves the right to health as a fundamental right, we must reflect on other events that also mark 40 years and mark before and after Primary Care (AP).

We refer to the International Conference held at 1978 in Kazakhstan, in the city which became known as Alma-Ata. The balance of the PA in Spain since the reforms in the 1980s is clearly positive.

A generation of professionals devoted their efforts and enthusiasm to work in a health center

A generation of professionals devoted their efforts and enthusiasm to work in health centers, and succeeded in combining secular commitments general practitioners with patients in their family environment, with scientific scientific modernity and with a new perspective on society and teamwork.

Hospital centralism and crisis have punished AP

Changes in society; the evolution of our country between excessive centralism and hospitals economic contraction that in the second decade brought austerity and crisis, has punished double PA.

Loss of attraction for the younger generation

With an older and more chronic disease population, the health system is oriented to meeting individual demands, rather than resolving health problems, with more population disease burdens, and the most serious with high levels of dissatisfaction and loss of growing attraction for the younger generation we.

AP 25 project

Pictures of protests referenced by Serafín Romero in his article.

Not much use of initiatives originating from this sector and especially family doctors has disappeared along with the evolution of the times: PA consensus document in 2000 where he begins to warn of crimes that affect the development of the first level of attention, namely 10 minute platform which leaves a guarantee effect on the road (and not just personal), which is APXXI Strategy from a great depth of diagnostics and a better approach to key therapies for solutions, and that we let go by the lack of professional leadership and ministers, creation Primary Care Forum and My conference, and finally our last initiative was promoted by Vocals Primary Care from CGCO, the Project ap25 by which we want to reflect on where it goes and, above all, where this level of care must go.

We think that big steps are needed, such as:

1. Every reform must be accompanied by a sufficient financing from the first level of care. Primary care funding must be proportional to the decision-making capacity and efficiency of care associated with it politically.

Primary Care Needs means competing with hospitals

Larger budgets for primary care must involve provisions various services required health, quality that competes with hospital care and is close to patients. With this, primary care will be attractive (for patients and professionals) and efficient (for the community).

2. Primary care will only have the best level of quality if used effectively by all social strata, especially those who have the greatest capacity to influence.

New technology opens new experiences in relation to patients

Focus the purpose of our assistance on the needs felt by the population and facilitate their participation, lead changes in the model of care to chronic care, continuing activities aimed at public health and developing community activities are strategies to be improved. New communication technology opens up new experiences about relationships with patients and the community that will be developed.

We must reduce work insecurity

3 Restore illusion, adapting professional staff to the socio-demographic realities of the population to be attended, reducing job insecurity, encouraging participation in management through recognition of managerial responsibilities, facilitating medical training, Continuous professional development and research, time management aimed at reconciling family and work life and a remuneration system that stimulates performance, commitment to the organization and professional recognition are priority steps for each change project.

We must find the root of the latest mobilization

4. One of the main complaints and reasons for growing and chronic dissatisfaction from primary care doctors is lost control of the treatment agenda and overloading work that prevents the time needed to realize diagnostic and therapeutic technical skills with the consequent increase in unnecessary tests, referrals and treatment.

It is important to discuss organizational formulas that break this growing trend (the adequacy of substitution policies, the definition of competency roles and efficient use of technology from anywhere, including professional addresses).

Professionals change from hope to gloom

For all this, Primary Care professionals have changed from expectations to depression, from resignation to anger and that's where we have to find the root of the latter. mobilization, with a stormy horizon that has no opening instructions.

We need the best leadership

CGCOM and the Primary Care Doctors Forum have demanded that the Ministry of Health, Consumption and Social Services immediately call Interregional Monographic Council to deal with urgent reforms needed by this sector with those responsible for each autonomous administration competent in the health sector.

Nwe need more than impulse. We need the best leadership from the profession in agora along with the commitment of the Ministry and the Autonomous Community.

Editorials are published in the journal Médicos y Pacientes.

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