José Polo García, president of Semergen.
The year 2022 for Primary Care was the time to recover normal care, however, the various consequences of the pandemic (increase in waiting lists, neglect of chronic patients, loss of healthy habits…) have caused a increase in demand that has once once more exposed the fragility of a care level and who has finished exhaust the patience of doctors. Fruit of this “satiety”, As explained by José Polo García, president of the Spanish Society of Primary Care Physicians (Semergen), a multitude of revolts have arisen to demand improvements that have turned 2022 in the year where Family doctors have clearly said “enough is enough”.
In an interview with Medical Writing, Polo García, reviews this situation along with other issues that have marked 2022 in Primary such as the renewal of the service portfolio, vacant places in the MIR, the management of sick leave or the economic endowment of the Action Plan.
After several years where the care situation in Primary has been worsening, 2022 has been the year in which Family doctors have said enough and have decided to go out into the streets in various areas of the national territory. Do you think the doctor’s patience has run out?
Yes, people are fed up and it is normal for there to be this movement of demand and protest. Another thing is that the current electoral moment is not the most appropriate moment for the reform of the PA, because it should be born of consensus and dialogue among all. Of course, the family doctor and the entire National Health System (SNS) are already very tired, bored and fed up.
You have spent years denouncing and warning regarding the problems that the specialty is experiencing. But this year both the population and the administrations seem to have become aware of it. Do you think that we are at the beginning of a turning point for Primary?
I don’t know if that will sink in or it will be that we are in an election year. In a year from now, there will be no electoral commitments, let’s hope that they will continue talking. I am skeptical that it is a turning point that will lead to improvements.
From the different administrations they have begun to link economic endowments to the plans and strategies for Primary. Are they not just wet paper anymore?
With plans and strategies you have to be very clear. What we say and have been demanding is that they be finalists. We are talking regarding an amount for Primary Care that seems like a lot when added up, but it must be divided among 17 autonomous communities and then it is necessary to see within the regional budget which chapter of it it goes to. It is not the same to go to payroll, to improve the problem-solving capacity, to training or to change the plumbing in health centers. You have to make a well-designed plan with the assigned cost of each of the items.
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“You have to make a well-designed plan with the assigned cost of each of the games” |
Where is it a priority for the money to go?
A very important human resources plan is needed because there is a lack of professionals, there is a lack of contracts that are interesting and attractive for doctors who finish their residency. It is also a priority to manage the demand for care, training and increasing the resolution capacity. The Primary Care physician must have access to diagnostic and analytical tests without any hindrance. This implies endowment of resources.
According to the Primary Care service portfolio, with its renewal, the Family doctor will be provided with a greater resolution capacity, who will have more diagnostic tests in consultation and will be able to request the same as the hospital physician. Is this a historical demand satisfied or is there still a long way to go?
It is one thing for it to appear on paper, but then you have to see in practice if it becomes a reality. In a while it will be necessary to analyze whether this single service portfolio is a uniform in all the autonomous communities and whether the doctor has access to the tests. If implemented as set out on paper, it would be a first step to achieve an improvement in services and the quality of care.
Steps have also been taken in the digitization of Primary Care and a budget has been linked for it. What should be invested in?
In recent years there has been a lot of talk regarding digitization, that Next Generation funds from the European Union are coming for it, but there is one thing that I wonder: Why does each regional health system have a different program for managing medical records? ? Even in some communities it is different between the hospital and the health center or from one area to another. It would have been easier to make one for all of Spain and not 17 different ones. Now you have to spend money on how to integrate all into one or how to have access. Technically, anything is possible, but we’ve spent a lot of money and now we’re going to spend more trying to unite something that should always have been together. The highest priority is the total unification of the SNS with access to patient data at any terminal in a health center. So it would not matter if the patient moves from one community to another and goes to one or another doctor.
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“It would have been easier to make a digital medical record for all of Spain and not 17 different ones. Now you have to spend the money on how to integrate all of them into one” |
Bureaucracy is another of the great ballasts in the struggle to have more time to care for the patient. As of January 1, they will refuse to manage IT due to hospital admission. Do you hope that this rebellion will change things?
In the area where I work, it has been established for a long time and it has an overwhelming logic. If the patient enters a hospital through the ER and is on sick leave, the person who has to fill out the sick leave for that patient is the doctor who is treating him and not one who lives 50 or 100 kilometers away. Any measure always takes time, there will be communities that will do it faster, but we will see it. There will even be some specific cases of an area that does not do it and we have been like this for three years. All the development of these measures always takes time.
Regarding the MIR, the 2022 call will remain to be remembered as the one in which more than 200 Family Medicine positions were not covered in the initial phase. Are you afraid that the same thing will happen in 2023?
It is a possibility that it happens and it would be very sad if it were so. We said it months ago the MIR system does not have to consist of getting a note. I roll a seven and I’m in and I roll a six and a half and I’m out. We already said that by dropping one or two points in 2022, all 200 places might have been covered. In 2023, the cut-off grade must be lowered and we hope that there will be no problems covering places because the medium and long-term solution is that there are more Family doctors to guarantee generational change.
The deficit of professionals, the exodus of doctors abroad and the risk of guaranteeing generational change have become evident in 2022. Do you consider that the SNS is at risk of ceasing to be universal and will not be able to guarantee equity in all territories?
Our health system is universal and with free access throughout the territory, but the problem is that if there are no professionals who can cover areas with difficult coverage, the possibility of access for the citizens who live there is hampered. This has to be fixed somehow. The provision of services in those areas may be compromised. What is at risk is the difficulty of accessing the SNS.
At the corporate level, Semergen has broken a record of participation in its 44th National Congress held in Seville. How do you assess having achieved this at such a delicate moment for Primary?
It has been a complete success, we are a very thriving and young society. We have a very high percentage of young doctors and there is a majority of women. I think that we have gradually resumed face-to-face activities with very powerful activities from all the work groups, with monographic and regional conferences where the desire of doctors to continue training and participate in scientific forums has been seen. The culmination was our National Congress reaching scientific excellence and unparalleled assistance.
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“We just have to see where the SNS leak is and fix it. We can do this together, talking and reaching consensus” |
In 2023, Semergen will be 50 years old. Do you think that Family Medicine, despite everything, is better than in the past or were there better times?
Our SNS is an exemplary and grandiose building. It was built by the generation to which I belong and among all of us. You have to think that we were much worse than we are. We have built the building, but it has leaks, the plumbing has not been changed… So, we have to renovate it by putting on a new roof, reinforcing the foundations and painting it. This is easier to do than what was done before, when going from an archaic system to a modern one. Now we simply have to take care of it and we don’t need such a beastly budget as before. We just have to see where the leak is and fix it. We can do this together, talking and reaching consensus.
And when we had just built the building?
Now we are conditioned by a great pandemic that has delayed all the activity of the SNS with uncontrolled waiting lists, increased demand for chronic patients, an increase in pathologies… The system is saturated and we must think that we are worse off than a few years ago. When the building was just built we were better, there were no leaks.
Looking ahead to 2023, what are the priority actions that Semergen is going to carry out?
First of all, we are going to celebrate our 50th anniversary. It is an important event where we are going to recognize the work done by many colleagues who have made it possible with their work and time for Semergen to be where he is. We also want to maintain cruising speed in training and research by resuming all the projects and training programs we have. All this while maintaining face-to-face activity in conferences and congresses. In addition, we will continue to claim the improvement of Primary, the training of the Family doctor and the presence of the Family doctor at the University. Illusion and desire will not be lacking, in the AND of Semergen discouragement does not appear.
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