Beyond what the daily data show, Spain is beginning to make gestures that demonstrate that the country is leaving the pandemic for good. This week, the Minister of Health, Carolina Darias, is bringing together in person all the health ministers of the autonomous communities. She has called them to a two-day meeting in the Canary Islands with the aim of starting the reconstruction of the health system. The authorities want to start at the base: primary care, the most devastated link in the last year and a half. Two medical congresses, one in Zaragoza and another in Palma, also explore these days, with conferences and round tables, the day after for the public system.
The health centers, again to the limit in Madrid: “There are delayed analytical, unchecked treatments, prescriptions that are not renewed”.
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Primary care professionals are “exhausted”, “in an agonizing situation”, “demobilized”, “arreactivos”. Several doctors and doctors who have spoken with elDiario.es about their expectations of the meeting between Health and the autonomous communities, which is expected to leave a photo of unity between authorities in the end of the pandemic. “We can not keep saying that we are the gateway to the system, that how well we work, which is the best we have, because we die. At some point we have to hit rock bottom to resurface and we are close to reaching that point,” says Rosa Magallón, family physician in Zaragoza and president of the Spanish Network of Primary Care.
Along with other doctors, Magallón has promoted a manifesto to “save” the public service provided in health centers. The document certifies that the “excess of activity in the pandemic” has exacerbated “old problems”. The pandemic has exacerbated difficulties that have dragged on for more than a decade, such as under-resourcing, but it has also created new fears. For example, that the interposed activity (telephone appointments, telemedicine, email …) is imposed on the face and that “has dire consequences for the poorest and oldest population,” warn professionals in the manifesto. “Not to mention the diagnostic and specialized delay that has occurred in this year and a half,” adds the doctor.
In the sector they are angry with the governments of the autonomous communities, in whose charge are the health systems, but also with the Government of Spain. The Recovery, Transformation and Resilience Plan does not include any specific investment for primary care, despite the fact that one of the strategic lines is to “strengthen primary and community care”.
Spain has faced the pandemic with health centers in the chassis. The Recovery Plan itself underlines this. “Even before the COVID-19 pandemic, the system already had significant weaknesses. Many of them have also been highlighted in the comprehensive country reports issued by the European Commission in the framework of the European Semester, […] such as the recommendation to strengthen Primary Care”.
The items spent by the communities in health centers did not recover until 2019 since the 2008 crisis, 11 years later, according to the latest consolidated accounts of the National Health System. That year the actual expenditure was 9,874 million euros compared to 9,317 in 2009, barely 15% of the total invested in health by the autonomies. Andalusia and Madrid are at the tail end of spending per capita; Euskadi, at the head. The most recent OECD health statistics, with data from 2017, confirms that health spending per capita in Spain (2,371 euros) is 15% below the European Union average (2,884 euros).
The President of the Spanish Society of general practitioners and family (SEMG), Antonio Fernández, calls for “sufficient budget, articulate means and human, technical and technological resources sufficient to maintain the system”. “If we want something else let’s decide, but let’s not keep fooling people,” says this family doctor with 40 years of experience in a village in Toledo.
Fernandez and Magallon agree that the pandemic has highlighted more than ever the “precariousness” of primary care. “But the coronavirus has also shown that we have been abandoned because it has preferred to implement flashy measures such as mounting large ‘ifemas’ instead of reinforcing. We had no telephone lines available, but we had large tents in front of hospitals,” criticizes the doctor from Zaragoza.
“By losing we have even lost the image we had in the eyes of society. It seemed that we weren’t involved or even that we were closed. That is unfair. Primary Care has given the face and has stopped 90% of the entire pandemic. It has prevented the collapse of hospitals,” claims the president of SEMG, who regrets the “decapitalization of the system. Account that is the only doctor in your health center (in Galvez) since the beginning of the summer.
Medical societies warn that it is the last chance to put resources in health centers. “In the next few years many colleagues are going to retire. There is no replacement,” says Lourdes Martinez, family physician in the Ensanche de Vallecas (Madrid) and one of the speakers at the first roundtable of the Congress of SEMERGEN that starts this Wednesday. The title is: Primary Care in Reconstruction. The staff of health centers have another appointment this week in Palma (Mallorca) with the XLI Congress of SEMFYC. There will be discussed, among other things, “community health in times of COVID-19”.
The Forum of Primary Care Physicians estimated in 2018 the deficit of family medicine in 2,700 positions. The lack of planning, cuts and poor working conditions have been depleting the templates. But it is not only a problem of lack of staff. “We have to recover the essence of the AP: the knowledge of the patient, the time for the attention to their chronic problems, recover the always battered community care, education for self-care … gradually recovering the presentiality. Only by seeing and touching can we diagnose”, demands Magallón. Martínez agrees. “We spend a lot of time on the consultation demand. That must be done, but the other – prevention, meetings with patients and health education – is not being done. We don’t just treat the disease.
The constraints of the pandemic have exacerbated, add several of the doctors consulted, the “hospital-centric vision”. “Even by citizens,” stresses Martinez. “All spending goes to hospitals. There are very good and very expensive treatments in the hospital, but most people do not need that. We aspire to a structural change. Spain is not the same as in the 70s when this model was designed: we have older patients, an aging population and technologies that would speed up the tests and diagnoses to which we do not have access, “he concludes.
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