The Andalusian Medical Union (SMA) has called off the day of strike in Primary Care that it had called for this Friday after reaching an agreement with the Junta de Andalucía to limit the agenda of family doctors to 35 daily patients and that of pediatricians to 25. The measure has been described as “patch” and “insufficient” by the rest of the union organizations, which are the ones that must ratify it at the sectoral table, who consider that problems in primary care are not exclusive to medical professionals , and with which, moreover, the autonomous Administration has not met. Nor has there been any meeting with the Union of Primary Care Physicians of Andalusia, which is the entity that has maintained indefinite strikes in health centers since January 20 and has already warned that it will maintain them.
In addition to limiting the number of patients per day, the agreement reached also includes continuity of care during the afternoon —for physicians who so wish— to avoid delays that may arise from having a maximum daily limit on the agenda. The percentage of patients who can be treated during that time has not yet been determined, but it will not exceed 25, as explained by the Minister of Health, Catalina García, in the appearance to the media. Continuity of care is an alternative that the Board has already offered since January of last year and to which health professionals can voluntarily take advantage of to clear up delays in their appointments. In addition, it is made explicit that users who come to the emergency room will be attended by specifically designated doctors and in the time slots that each health center establishes, without these consultations being included in the ordinary agendas.
“This was one of the measures we were demanding,” said Rafael Carrasco, president of the SMA. “It is an agreement that will benefit the population because it will improve assistance, since when we have more time to care for patients, it is less likely that they will return for a new consultation. The limited agenda is also necessary for the quality of life of doctors, ”he has abounded.
The Board’s commitment has been enough for the SMA —which since last December has staged different rallies in defense of quality Primary Care— to renounce its strike threat, announced for this Friday. However, for the Union of Primary Care Physicians of Andalusia, responsible for the indefinite strikes of family doctors in the community that began on January 20, the measure does not satisfy their demands and they will maintain the indefinite strike. “For us, the agenda of 35 patients is, basically, maintaining what we officially have now. We defend that the ideal would be 20 appointments on demand so that professionals can free up two and a half hours to make external visits, prevention programs, training activities, teaching…”, explains Carmen González, its president, who also does not understand the distinction in the number of patients with pediatricians. “We don’t know what the difference is between caring for an elderly citizen and a child,” she says.
The follow-up to the strike called by that union, recently constituted and which is not yet on the sector table, is still very residual, around 2.5% daily, according to data from the Board. “When the minimum emergency services and in rural areas are 100 and 40%, it is difficult for there to be a large follow-up.” González reproaches the council for being the ones who had called a strike, not having held a single meeting. García has argued that by not being part of the sectoral table, the Andalusian Health Service cannot meet with them.
“The solution cannot be agreed only with doctors”
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The agreement reached with the SMA must be ratified within a month by the rest of the organizations that do form that table and that, from the outset, have shown their astonishment that the commitment of the Board was acquired with a single union before make it known at the technical meeting scheduled for this Thursday. “It seems wrong to us that the agreement was adopted with only one union of those that make up the sectoral table,” says Victorino Girela, head of Health at Csif in Andalusia. “The solution to Primary Care problems cannot be agreed only with an organization that only defends doctors”, he adds.
That idea is also defended by the UGT. “The problem of Primary Care is not a single group, it is a system that as a whole does not work,” argues Antonio Macías, regional secretary of health, socio-sanitary services and dependency of the organization in Andalusia. Macías is also very critical of the measure agreed between the SMA and the Ministry of Health. “This agreement worsens the conditions of the professionals and that of the patients, because in the end it means lengthening the working hours and after more than eight hours undergoing consultation, the care provided is not better”, he indicates.
“The solution is not only to reduce the agendas, we must strengthen other professional categories and diversify. This is just a patch”, adds Girela. “There is a lot of room for improvement, and not just for medical professionals. There is a lack of psychologists, who would avoid the abuse of Primary Care consultations, there is a lack of physiotherapists and social workers, the bureaucratic procedures could be dealt with by the highly qualified administrative staff that we have. A comprehensive solution has to be given in all categories… ”, she abounds.
Both agree that this agreement is not going to solve a problem whose roots are rooted in the lack of health professionals. A scourge that the president of the SMA – who estimates between 1,000 and 1,500 the number of doctors that Andalusian Primary Care would need – and the Minister of Health who has demanded from the minister an extraordinary and monographic interterritorial advice to address the increase in MIR positions in Spain.
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