The proposals submitted to the XII Social Affairs Commission of the Chamber as part of the work on the proposed law C. 1298 Quartini. Among other things, the Smi requests the modification of the ceiling on healthcare personnel spending, the reintroduction of contracted personnel in the facilities, the single contract for doctors working in the NHS, the decriminalization of the medical act and additional measures to combat violence against healthcare workers.
28 JUN – The National Secretariat of Smi (Italian Doctors’ Union) has presented its proposals and observations to the Chamber as part of the fact-finding activity that the XII Social Affairs Commission is carrying out regarding the proposed law C. 1298 Quartini, containing “Provisions concerning the financing, organization and functioning of the National Health Service as well as delegation to the Government for the reorganization of tax breaks relating to complementary health care, its observations and proposals”.
Regarding the organization of the National Health Service, explains the Smi in a note, “we are of the opinion that today we have reached serious critical issues that affect all sectors of care starting from general medicine up to the area of medical and hospital management. In these areas it should be noted that we cannot ignore the public role of the doctors who work within them, where by public role we mean both an employment relationship and a contracted one that continues to provide a direct interface between the Public Body and its doctors, without the need for companies or cooperatives within the SSN that operate as intermediaries in the selection of medical and healthcare personnel”.
As regards general medicine, for the union, “with the establishment of the Community Houses (CdC), the work of doctors will not improve from an organizational point of view, nor the services to citizens. Indeed, the obligation to work for 38 hours a week inside the Community Houses with the obligation to open peripheral offices, by young doctors, will further distance the new recruits, mostly women, from the profession as it will go well beyond the 40 hours of work per week. For general practitioners under agreement, the time has come to find solutions to guarantee protections in matters of pregnancy and maternity, for the use of sick leave and for the recognition of accidents at work, as the bipartisan parliamentary motion (no. 1-00618), approved in the XVIII Legislature, also with the contribution of the SMI, stated regarding the need for greater protections for contracted doctors”.
“Medicine of services – saccording to the Smi – it needs a turning point, it is necessary to modify the law 502/92, for the reopening of the area of medicine of territorial services and the full integration of the doctors of medicine of services in the company organizations, allowing the achievement of the 38 hours for the holders not yet full-time, who could also be employed for the operation of the health houses and to regularize on a permanent basis, those few hundred doctors, more present in some regions such as Lazio and Campania. These doctors who are currently precarious, could benefit from the regularization rules, already foreseen for the contracts of the medical management, and find, easily and substantially with equal resources, a stabilization in the Ssn”.
“The hospital professions and those in the healthcare management area – the observations continue – have been in crisis for some time with the flight of hundreds of professionals from the public service, which forces them to work at an unsustainable pace, especially in the emergency rooms and with the dramatic de-medicalisation of the ambulances of the 118 emergency emergency system. The area of healthcare management must be equal to those of their European colleagues to respond to the serious crisis of the profession and initiate a reform of the 118 system with the establishment of the single role of the emergency doctor”.
For waiting lists “Huge investments are needed for the NHS with a GDP/health expenditure ratio in line with countries such as Germany and France so that it is possible to provide services within adequate times with respect to the pathology and treatment needs, ensuring that all Italian citizens have use of the Essential Levels of Assistance. We are not convinced that, to combat the shortage of family doctors, the aim is to transfer functions to pharmacies, allowing, on the one hand, pharmacists to prescribe tests paid for by the National Health Service in the absence of any clinical indication from a doctor, on the other hand to cut the number of prescriptions. This is the worst way to act: they want to find the solution to waiting lists by cutting services and putting improper pressure on doctors”.
The final proposals of the Smi for a relaunch of the NHS are:
1) Amend the Legislative Decree of 6 July 2012, n. 95 which establishes a ceiling on healthcare personnel spending.
2) Amend law 502/92 for service medicine to reintroduce contracted personnel into the structures, with standardization of the contractual areas provided for by contracted medicine.
3) Shift the amount spent on paid doctors (purchasing goods and services) onto managing doctors.
4) Provide a single contract for doctors working in the NHS.
5) Pay close attention to specialist training and establish a university specialization school in general medicine.
6) Decriminalization of the medical act and additional measures to combat violence against healthcare workers.
7) Use part of the funds from Mission 5 of the PNRR to certify gender equality in healthcare and medical areas.
8) Follow up with adequate investments to the bipartisan parliamentary motion (no. 1-00618), approved in the XVIII Legislature.
June 28, 2024
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