Primary care is collapsing. It was already collapsing before covid, but political leaders preferred to look the other way, hiding under the mantra that says "Spain has the best healthcare in the world". But the pandemic was responsible for making visible what had been so eagerly tried to hide: that the cuts, especially those of 2012, had seriously injured the first level of care, a key part of the health system.
Now is the time to heal these wounds to prevent them from becoming gangrenous, and they must be healed 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 deal with the tsunami that is upon us", 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) , with reference to the shortage of professionals that is approaching due to retirements.
what to do We need to inject money into primary care, both by the Spanish Government and the autonomous communities, improve the working conditions of doctors, offer them incentives so that they do not leave the specialty, extend the retirement age, expand the number of 'nurses and strengthen the role of administrators, expanding their tasks, so that they take on tasks that now fall to and overwhelm overworked doctors.
In addition, strengthen multidisciplinary teams (incorporate physiotherapists, social workers, psychologists, nutritionists...), create a specialized primary care unit in the Ministry of Health to oversee assistance, improve coordination with communities and allow in the health centers to organize. And also, strengthen links and collaboration with pharmacists, a key piece for detecting vulnerabilities in the system.
This is indicated by a report drawn up 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 autonomous regions, "in the framework of the global concern for the precariousness, temporary nature and lack of personnel that threatens the sustainability of Spanish and European healthcare in the short term" due to the 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, driven also by changes in demographics, the health care needs and expectations of the population and innovation", he points out.
After having physically visited Aragon and Castile-La Mancha (January 2023) and having held 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 WHO experts, led by Zapata, make it clear that Spanish primary care is undoubtedly the best in Europe, because it attends to almost all the needs of citizens at no cost to them (just stop oral and ophthalmology band, and there is no co-payment for a medical visit). This explains, in large part, that we have one of the longest life expectancies. But this jewel is losing its luster due to a lack of investment: "The funds allocated to primary care have been decreasing over the last fifteen years, which has resulted in an ever-widening gap between this level of care and hospitals" , the report states.
A lack of resources that has clearly weakened the health centers and, above all, the professionals: "The effects of the lack of investment in the APS are already visible in the increase in problems of recruitment and retention of staff and deficiencies in equipment and infrastructure", he points out.
The situation of doctors deserves special attention: “Ensuring the retention of staff for a high-quality PA depends to a large extent on the employment status and working conditions of its workforce. However, over the last decade, conditions for professionals have gradually deteriorated, contributing to exacerbating retention and recruitment concerns, including the emigration, albeit insignificant in general terms, of professionals trained in Spain".
The Ministry of Health predicts a substantial shortage of around 9,000 family doctors by 2028 due to upcoming retirements (60% of family doctors are over 50) and working conditions. “To mitigate the effects of the expected shortage, solutions are being developed, such as expanding residency vacancies in family and community medicine, encouraging flexibility in the retirement age and promoting the recruitment of foreign-trained doctors ", says the report. 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 doctors have more than 40 patients a day and spend less time on each patient than the European average), job stability and flexibility, "can leading to higher recruitment rates and better staff retention”.
In short, the WHO urges to recover primary care and adapt it to the new times. Life goes on.
