In this month, half the world will desire intimate, more necessary: ¡Salud! The keepers of this treasure are the Primary health Care (AP), the first line of the National Health System in the battle against viruses, bacteria, and anxieties, but that fight now, in addition, by reversing the aftermath of the economic crisis on the sector. Competences in Health care are transferred to all regional Governments since 2001, but, although the doctors of Andalusia and Catalonia have starred in the protests of these days, the background of the complaints is the same in all communities: the lack of time to attend to each patient.
in view of the ongoing protests of doctors in the last few years, the Ministry of Health, Consumption and Social Welfare agreed in the meeting of 16 November, with the Forum of Primary Care Doctors, which was to develop a document that would address the situation. That will be addressed in an inter-Territorial Board exclusive to treat AP, as demanded by the trade unions in the sector.
“The situation is affecting our mental health,”
Lluís Cap. Christopher Castro
Four days of strike with a follow-up of over 60%. Four days of consultations empty and white coats in the street. That was what he did lack in Catalonia to the Generalitat to put on the table of negotiation a package of urgent measures of 100 million euros to reduce the overhead of the primary care physicians from the Catalan Health Institute (ICS).
The situation was unsustainable. Repeats Lluís Cap, 62 years of age and physician the primary care center (CAP) Centre of Sabadell, which has a population of 31,000 inhabitants. In your backpack carry 39 years with the whisk, the most as a rural doctor. “There is a lot of saturation. In my CAP got to be six doctors with more than 2,000 patients, and this center is the one that has more older people around Sabadell, with more chronic diseases,” he explains. Usually have an average of 38 visits face-to-face, although with no face-to-face reaches 42 and, in some peaks, exceeds 50 per day. “In three days I got to see 139 patients”, he says.
Cap is already hardened in the protests. During the first cuts of the era’s president Artur Mas started a process of litigation against the ICS because, he says, “changed the regime of guards to close centers.” Also promoted a collection of signatures to remove to their territory manager and participated in other attempts to strike. The unemployment, this time, believed that it was necessary: “The situation was beginning to affect our mental health.”
This doctor ensures that this strike has served to “empower the young professionals to see that you can put against the ropes to that abuse.” And says: “it is Not a bad deal, but he is poor, and it’s not going to be able to compensate for the situation. But have acknowledged for the first time that there is an overload”. He tapped him on the Thursday to make minimum services and the Friday returned to work. Had 29 visits. “People have tried not to come. Some even excusing and gave us encouragement”, it summed up that day. Assumes with resignation that the next week will be chaotic, because the strike forced them to postpone appointments.
In 2015, the prestigious medical journal The Lancet placed among the 10 best in the world. A year later, it fell to 19th place, where it remains stagnant until today.
Even so, with a spending per citizen of about 1,500 euros per year, half that of Germany, France or the United Kingdom, Spain has the highest life expectancy in the world, a public health toe cap and a few doctors who are the professionals most valued by the citizens in the CIS surveys of each year. Where is the trick? “In medical, we left the skin, we have a vocational profession and sacrifice everything for the health of the patient”, clears Vicente Matas, a member of a Primary Care Medical Organization Schoolboy.
“The damage of the crisis to primary care has been huge; it is the basis of the entire health system and doctors have a care pressure tremendous; it’s a rhythm of stressful work,” explains Concha Sánchez Pina, president of the Spanish Society of Pediatrics of Primary Care (SEPAP).
According to data from the ministry, 38% of family doctors have quotas of between 1,500 and 2,000 patients, which represents nearly 44 queries per day. “We could claim many things necessary, but we have reached such a limit that the only thing we ask is time,” says Cristina Sánchez Quílez, secretary of primary care in the Confederation State of trade Unions Medical (CESM).
“at The beginning of the crisis we assume the proportion of patients of other colleagues of the low or vacation at zero cost, to avoid cuts that affect the sick; but the crisis has already passed and that has become an obligation imposed on us by the Administration,” complains Sanchez Quilez. “We have worked together in the tough times, but Governments have taken advantage of that. And here we come”, plant.
The doctor, like all primary care practitioners consulted, he confesses that many times waive requested low required so as not to overwhelm the companions: “In Madrid there have been two cases of doctors who have suffered a heart attack in full consultation. Sold that Spain is better, but the healing does not make case”, judgement of the secretary of CESM.
What happened last week to Victor Pedrera, a family doctor in the Health Center of San Blas, Alicante, illustrates this complaint. “Today I treated my patients more than my partner, who is on holiday. The rate of substitution is zero. Many days I just with 40 patients, I start with 25 above and between emergency, unforeseen…”, he laments. “In the end you are on a piecework basis, it is very stressful because of the level of responsibility is very high and, in addition, you feel very frustrated not to be doing things as they should do. I feel that I am not what I can give in my work. You feel as if you were bailing water from the ocean with a bucket,” he continues.
queries are saturated. The doctors, overwhelmed. And that, despite the voluntariness, has already been transferred to the patient. The health barometer of the CIS for 2014 reflected that the 57.6% of the users are not getting appointment for the same day with your gp. In the one published this year that percentage is already 62.5%. The dreaded delay has already entered in the primary care.
Between 2010 and 2014, the investment in the National Health System was reduced by 12.5%. If this figure is worrying, in primary care, it was worse, coming in at Bahsegel 16.1 per cent.
According to data from the college Medical Organisation, the spending per capita was cut by nearly a third in some communities, like Castilla-La Mancha or Andalusia. Across the State, the share of GDP allocated to Healthcare has been falling year after year: in 2009 it was 6.5%; five years later it was 6% and the budgets for 2018 have been cut even more to drop in a 5.8% of GDP, a figure far already to the 7% that doctors considered to be minimal.
“The problem is not just money, it is how you invest,” explains Sanchez Quílez, “and sell more to cut waiting lists in specialists, to create large hospitals with machines expensive, things that are very media with return policy”.
Sánchez Pina critical that those responsible for the Health “sins of building large hospitals with the machines more expensive; politicians love to inaugurarlos. But if the base of the system, which is the primary care, it does not work, the emergency of the load and the waiting lists will be endless: that magnificent building you will fall miserably by not securing its foundation.”
Low replacement
One of the measures against the crisis more dire for the sector was the reduction of replacement rates to 10%: out of every 10 physicians who were retired, only hired one. Although a year ago the Government restored this rate to 100%, you have lost 27.800 squares of primary care, according to data from the Ministry of Territorial Policy and Public Function. But the sick are the same, and the population is increasingly ageing, and therefore more in need of a primary care physician.
And also the medical age. 60% in primary care has more than 50 years. There are more doctors over the age of 60 years (17.7 per cent) children under the age of 40 (17,7%). In pediatrics, this situation is more serious: 210,000 children will be left without specialist each year during the next five years. The president of the pediatricians says that only 75% of the squares are covered by the graduates. “The model for child care-Spanish is in serious danger of disappearing for lack of foresight and poor management of the Administration,” warns Sanchez Pina.
“there are No pediatricians because the cuts have created a precarious labour conditions in primary care. It works best in hospitals and in private healthcare; the pressure of care living in the health centers is unbearable,” she explains, “many take anti-anxiety medications to be able to pass query”. And he warns: “it Is terrible to say, but either take action now or there will come a time that they will only have a pediatrician children with money.”
“The lack of time has an impact on the patients”
The family doctor Carmen Gonzalez. Garcia-Santos
Shortly before eight in the morning, Carmen González turns the computer of the health centre of the district of The Perchel, Málaga. It has nearly all the appointments covered. One every seven minutes during four hours, with a break of 30 minutes. It looks bad, but the reality is different. The attention to the first patient, at 8.15, which lasts 16 minutes. The second, 7 minutes, and the following two exceed 12. They are barely nine in the morning and already there is a delayed cumulative of 20 minutes. “Is what we say to the managers, and heads: come one week and you will see how the day-to-day has nothing to do with the theory,” he stresses. “The lack of time affects the patients, who are the main losers,” he adds resigned.
The time spent is the main battle of the physicians in andalusia. They ask for a minimum of 10 minutes per person. Also greater flexibility in their schedules to not having to deal with a watch in hand. And more help in query, because you say they are being forced to exercise of warders or nurses. It is a battle that began the Medical Union of Malaga and, finally, the whole of Andalusia stopped on Tuesday. Among their claims, a greater coverage of the low, or a program against attacks, according to Rafael Carrasco, president of the Medical Union Andalusian.
The Service Andalusian of Health (SAS) recognizes some of these needs. Include them in the Renewal Strategy, promoted with the collaboration of the doctors themselves. I’m surprised that the protests would intensify now. “A few years ago it would have been more understandable”, explains José Luis Gutiérrez, director of the Health District Malaga. The regional government of Andalusia has contracted 1,700 professionals in the last year. Its president, Susana Diaz, do not agree to the 10 minutes and ask for time to “begin to notice the improvements.”
“I Know that I have to wait a little bit, but that you serve the required time is very important. That’s why I don’t change doctor,” says María José Chacón. It’s the last patient of the morning and leave 70 minutes later than scheduled. And your doctor has not rested. Has taken to 11.2 minutes to attend to every one of their 28 patients, and missing home visits and to resolve cases in the Center of the High Resolution of the district.
45 cited in an evening over the emergency room
Carolina Perez, a medical doctor in San Sebastian de los Reyes. Samuel Sanchez
“Today is this quiet, is that on Friday afternoons, no one gets sick,” he says with breeching Yolanda Carrasco. Dr. Pérez de la Campa attend to your query at 15.00. There are already patients waiting at that time. Carrasco had an appointment at 4.00, but has come before. There talk with another well-known neighborhood on the greater than is the girl. Carrasco asked for time on Wednesday and got on Friday. Every five minutes, sometimes seven, enters a patient. “Are 20 years in a health center and I have already taken agility”, presumed to be the doctor of the health center Rosa luxemburgo, San Sebastian de los Reyes (Madrid). On the evening of Friday, there were 45 cited, but appeared five emergency department minors, that the family doctor drawn between one and another appointment.
At a given time, a lord enters “by the face”, according to another waiting turn. “Shouldn’t you, ask your time as you all,” she complains. The others nod. Remains in consultation for nearly 10 minutes. It was the family of a sick urgent: the doctor called an ambulance and filed a notice to the 061. The outside still think that there are people with a lot of face. No one knows what goes on behind that door.
A lady appears with her teenage son, with pain in the leg and, already that is, take the opportunity to ask for the complete medical checkup; you don’t need, but the doctor, determined the urgency of the case, check out, fill out the medical history and may recommend a vaccine. While waiting outside six patients, but the delay is just 20 minutes.
When they leave the mother and the child, there is a 15-minute closed door. In the waiting room no one says anything, but everyone looks at each other wondering, “what will you do?”. Bureaucracy: notes on a tab, a change in treatment, dealing with a low and agree with the nurse for the shot of the guy.
At 17: 30 it takes a few minutes of rest. “It is not the complicated day and I’m going on time”, is happy. And takes advantage of it to go to the bathroom. A luxury, says, that few times can allow. Advantages of the Friday miracle.
