Primary care in Andalusia still has not emerged from its state of collapse that the Government of Juan Manuel Moreno does not seem to know how to stop. Aware, the president of the Board recognized last Wednesday in the debate on the state of the community “failures in management” and some initiatives that, however, the health unions have rejected as “occurrences, unrealistic and not very credible,” according to the interlocutors consulted agree.
The measures announced by Moreno and which, according to the Ministry of Health, have begun to be implemented throughout the community, affect the improvement of the management of the agendas, where “room for improvement” has been confirmed, according to the popular leader. The first involves limiting reservations for appointments made in health centers to 7%, after having verified that “in some places up to 50% of appointments were reserved to deal with possible unforeseen events.” “This will improve the functioning of the system because it will lead to more appointments being available,” said the president of the Board. The second proposes increasing continuity of care, encouraging all family doctors to be able to work in the afternoons. An extension of the working day that, according to Moreno, “meant 240,000 more hours of attention to Andalusians” in 2023.
Without a doubt, the most innovative is the third initiative. The president of the Board committed that any Andalusian be seen within 72 hours, even if it is with a family doctor who is not his or by telephone by a doctor from another health district or from another province who has availability. This measure has been implemented since December 2 in 87 health centers and will be extended next to 181, all in Seville, Jaén and Cádiz, as confirmed by the spokesperson for the Board, Carolina España, in the press conference after the Governing Council.
Except for the Andalusian Medical Union (SMA), the rest of the worker organizations that are part of the negotiation table on health matters insist that the ministry has not made them participate in these measures, nor has the College of Physicians. “Primary care is moving forward with great difficulty thanks to the efforts of doctors and the logical thing is that, before adopting actions that are going to have a great impact on a large volume of the population, they share them with us and with consumer associations” laments the president of the Seville College of Physicians, Alfonso Carmona, who, not knowing the measures directly, prefers not to comment on them.
The union organizations have made their assessment: “It seems that we professionals are being accused of sitting with our arms crossed, implying that there are doctors who have plenty of time to care for other patients or take on the demand by working for themselves.” in the afternoons,” says Vitorino Girela, head of the Csif Health area in Andalusia. “They combine the occurrence with approved and failed measures,” says Luis González, spokesperson for the CC OO Health Federation.
González alludes to the expansion of continuity of care, a measure implemented in to limit the wait for in-person consultations to four days and those requested through Salud Responde to five and which offered the possibility to professionals who exceeded a certain percentile in their delay in care for patients who could do afternoon shifts, an option that had already been applied since the end of December 2021. “Although it can help to lighten schedules, very few professionals want to stay to work in the afternoon,” Rafael acknowledges. Ojeda, president of the SMA.
Victorino Girela, head of Csif’s Health area in Andalusia, is more forceful: “The ministry has been very stingy when it comes to opening its hand to continuity of care in recent years, but we are in a context in which “Professionals are already saturated, they do not want to work more hours, what they want is to work in better conditions and better paid.” “You cannot strain the system with solutions that have already been applied and have not solved the problem,” says Antonio Macías, general secretary of the UGT Andalusia Health Federation. The Ministry of Health indicates that each district and health center will plan the continuity of care based on the expected demand and that all professionals who do not meet their quotas or do not have as much demand can be accommodated, to respond to the not covered.
They also do not understand the 7% limitation on the number of appointments that can be blocked. “The only thing left for users right now is to go to the center, they queue very early to beg for an appointment, and even that is going to be taken away from them,” Macías questions. His colleague from CC OO goes further: “Instead of at 7 in the morning, they will have to arrive at 3 because there will be fewer spaces available.” The ministry sources consulted have not been able to specify what percentage of the health centers block 50% of the appointments, an amount that has surprised the union interlocutors consulted, and they explain that the percentage of 7% is sufficient to cover the demand. non-delayable occurrence. “The normal thing is that five appointments are booked out of the 35 daily that doctors are assigned, 17%; with 7% they are reduced to two per doctor,” says González.
More professionals and better working conditions
But where the criticism is unanimous is in the guarantee that all patients who cannot obtain an appointment through the SAS application or by telephone must be seen in less than 72 hours, even if it is by a doctor from another province. “We have already informed the department that this measure is not going to work,” warns Ojeda. “What differentiates primary care is the proximity, the direct relationship between doctor and patient, what must be guaranteed is that patients can be seen by their doctors and in their health centers,” he adds. “It is an aberration, what treatment is a professional from Huelva going to give to a patient from Seville whom he does not know, who does not know if he is prone to not taking his medication… And what that patient will do when he hangs up is go back to Make an appointment with your family doctor,” explains González. “If this weren’t so tragic, it would almost seem like a joke: We listen to you and, with luck, we find out what’s happening to you,” Macías ironically says.
The interlocutors consulted insist that the only way to resolve the chaos in primary care is to improve management and “We must increase the staff of professionals, reduce quotas, create administrative staff to support consultations, review the working conditions of the templates…”, which is in the pact, which is not fulfilled, González warns. From the SMA, the only one that did not sign that pact, more doctors are also being demanded. “According to the Annual Report of the National Health System, in 2023 the rate of doctors per 1,000 inhabitants in primary care in Andalusia was 0.73, when the state average is 0.77 and, however, the reinforcements of the counseling staff are directed to other professional categories,” indicates Ojeda.
Broken pact and failed reinforcement plan
It included allocating 25% of the health budget to primary care – which in the 2025 budgets has increased to 35% -; shorten professionals’ agendas to 35 and 25 patients for doctors and pediatricians – a measure whose effectiveness Moreno recently questioned; regulate care continuities—afternoon consultations to reduce waiting lists—; encourage positions that are difficult to fill by increasing, among other measures, the salary of doctors and nurses by 150 euros; an increase in management personnel (411 administrative staff) to debureaucratize consultations; or promote the presence of professionals from different specialties; in addition to improvements in access to professional careers. A year and a half later, the pact monitoring table has only met once and in protest of the non-compliance they called
With these measures, Moreno aims to reduce the discomfort of Andalusians, who, in addition to the collapse of primary care, are those who wait the longest in Spain for surgery. The previous reinforcement plan, which the Board presented as revolutionary, aimed to reduce the wait for a doctor’s consultation to four days, the average almost three years later, according to the Ministry of Health, is 9.12 days. “These are data from 2023, but now they are much worse,” acknowledges the president of the SMA.
