by Roberto Polillo and Saverio Proia
11 GEN – Dear Director,
we read with pleasure and a little satisfaction the proposal of the Regions and the Ministry of Health for the renewal of the ACN of general medicine published in QS. A proposal that does not provide for the transition to the dependence of general practitioners proposed by us but which in fact, if implemented, is a substantial approach to that model.
Of course, the draft is very reminiscent of the agreement on internal outpatient specialist more than the dependency contract but in the meantime, compared to the initial hypothesis of the Regions, the third hypothesis of accreditation of the studies of general practitioners is abandoned and therefore sent to the attic the privatization of the same. This is an extremely positive fact.
In the current proposal of the Regions, the same ceiling and hourly debt of the CCNL of the medical management and of the ACN of the outpatient specialist is introduced, thus overcoming the first taboo of the complete self-determination of the category in terms of service rendered. A device from which a very specific effect derives because with it the general practitioner, whether he works in his office or within the community house, will have to carry out initiative medicine activities.
It is undeniable that the proposal represents a compromise between the two initial options, ie the maintenance of the current conventional relationship or the transition to the dependent relationship tout court; however, it is a good compromise, a respectable award between the two hypotheses, which if implemented would enhance the role of the general practitioner making him an integral and organic part not only of the community house but of the social and health district itself and therefore of the Local Health Authority.
The contract is in fact a “social construct” that governs the employment relationship not on the basis of abstract principles but on institutions and norms that tend to achieve specific objectives.
In the previous months we had always intervened on QS with an organic hypothesis of reform of primary care that we find in large part in the current proposal of the regions, a proposal that took up, contextualizing them, the elaborations on the reform of general medicine produced over the years by the CGIL and in particular by the FP-CGIL Medici. A trade union organization of millions of individuals, the largest European trade union, which certainly cannot be represented in terms of lobbying as rashly did a GP who should show more caution in the use of words.
Of course, we would have preferred, as the Iberian and Lusitanian experience of the dependent family doctor positively teaches, a family doctor no longer a freelancer but a medical director inserted in what we have defined a “supply chain contract” with its peculiarities but with the same rights, duties, guarantees and perspectives, starting from the same post-graduate specialization training course, as his other medical executive colleagues employed by the Health Trusts.
A new doctor with a “primary” role in his area of expertise; a battle that we will continue to carry on but which in any case makes us appreciate the proposal of the regions.
And then, if the renewal of the ACN of general medicine took over the proposal of the Regions and the Ministry of Health, never say never to any improvements.
Roberto Polillo and Saverio Proia
January 11, 2022
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