Primary care (PC) is collapsing. She was already doing it before Covid, but political leaders preferred to look the other way, hiding under the mantra that “Spain has the best healthcare in the world.” But the pandemic made visible what had been tried so hard to hide: that the cuts, especially those in 2012, had seriously hurt the first tier of care, a key piece of the health system.
Now is the time to heal these wounds to prevent them from becoming gangrenous and it must be done now and decisively, especially in what has to do with the lack of doctors, which will be even greater in the next five years. “We must face the tsunami that is coming,” says Tomás Zapata, head of Unit, Health Personnel and Service Delivery of the Division of National Health Policies and Systems (WHO Regional Office for Europe) in reference to the shortage of professionals that is looming due to retirements.
To do? We must inject money into primary care, both by the Government and the autonomous communities, improve the working conditions of doctors, offer them incentives so that they do not abandon this specialty, extend the retirement age, increase the number of nurses and reinforce the role of administrators, expanding their tasks, so that they assume tasks that now fall to and suffocate overburdened physicians.
In addition, reinforce multidisciplinary teams (incorporate physiotherapists, social workers, psychologists, nutritionists...), create a specialized primary care unit in the Ministry of Health to supervise care, improve coordination with communities and allow health centers organize. And, also, strengthen links and collaboration with pharmacists, a key piece to detect system vulnerabilities.
This is indicated by a report prepared by WHO-Europe, published a few weeks ago, on the situation of primary care in Spain, and which has had the collaboration of the Ministry of Health and the autonomies, "in the framework of the global concern for the precariousness, temporary nature and lack of personnel that threatens the short-term sustainability of Spanish and European healthcare” due to a lack of professionals and the proximity of thousands of retirements, the report details.
“In Spain, primary health care has played an important role in achieving good health outcomes among the population.” But since the beginning of the 21st century it has shown “signs of fragility.” “After the pandemic, the primary health care system is at a crossroads, also driven by changes in demographics, the population's health care needs and expectations, and innovation,” he notes.
After physically visiting Aragon and Castilla-La Mancha (January 2023) and holding meetings (February-May 2023) with the political leaders of the communities and a large group of associations and organizations of doctors, nurses and patients, the experts of the WHO, led by Zapata, make it clear that Spanish primary care is, without a doubt, the best in Europe because it addresses almost all the needs of citizens at no cost to them (it only leaves out oral and ophthalmology, and there is no co-payment per medical visit). This explains, to a large extent, why we have the longest life expectancies. But that jewel is losing its luster due to lack of investment: “Funds allocated to primary care have been decreasing in the last 15 years, which has resulted in an increasing gap between this level of care and hospitals,” the report indicates. .
A lack of resources that has clearly weakened health centers and, above all, professionals: “The effects of the lack of investment in PC are already visible in the increase in staff recruitment and retention problems and deficiencies in equipment and infrastructure,” he points out.
The situation of physicians deserves special attention: “Ensuring staff retention for high-quality PA depends largely on the employment status and working conditions of your workforce. However, in the last decade, the conditions of professionals have gradually deteriorated, contributing to aggravating retention and recruitment concerns, including the emigration, although insignificant in general terms, of professionals trained in Spain.
The Ministry of Health foresees a substantial shortage of around 9,000 family doctors by 2028 due to upcoming retirements (60% of family doctors are over 50 years old) and working conditions. “To mitigate the effects of this expected shortage, solutions are being developed, such as expanding residency vacancies in family and community medicine, encouraging flexibility in retirement age, and promoting the hiring of foreign-trained physicians,” the report states. . But, despite the increase in the number of places for family and community medicine, the vacancies have not been filled in the last two years.
Improving the working conditions of professionals, including ensuring an adequate workload (35% of physicians have more than 40 patients a day, spending less time on each patient than the European average), job stability and flexibility, “can lead to higher hiring rates and better staff retention.”
In short, the WHO urges to recover primary care and adapt it to new times. Our lives are in it.
