The unbearable lightness of the debate on the future of general medicine

by Alessandro Bonci

03 NOVDear Director,
a few days ago the news came that the Tesla Model 3 is the best-selling car in Europe in 2021. It is not so much surprising that it is a full electric car, but rather the fact that Tesla has certainly not decided to rely on a network of dealerships and workshops like the traditional auto giants, but on an online sales model and remote assistance.

While the world is changing, some obviously still believe that the gateway to the national health service could be the mobile phone of general practitioners or the clinics in the “basements” in the name of proximity.

Among other things, doctors now tried by 18 months of contactability h12, by bureaucracy and by an IT revolution that has complicated daily activities, instead of simplifying it.

One of the most glamorous topics of the last period is certainly that of the “Convention or Dependence”, a debate between the surreal and the paradoxical, among other things mostly carried out by retirees or retirees of both factions.

Thinking of solving the critical issues of the territory simply by modifying the employment relationship appears to be such a trivial solution that it cannot be the result of sentient minds, but engaging in a debate also means having a lot of “free time”.

It does not appear that the productivity of civil servants is as extraordinary as some say, let alone that the ties and ties related to an addictive relationship can guarantee the elasticity necessary for a profession so heterogeneous in terms of tasks and functions such as territorial assistance. Obviously then we are free to believe the Gabanellian narrative of freelance GPs who whiz around in their Maserati and answer the phone while playing golf.

Nor does it seem an intelligent solution to risk losing, one of the pillars of the ACN, the relationship of trust with the treating doctor which, while on the one hand it is pleasing to the citizen, on the other it is also a spur for the doctor to guarantee an appreciated service. by users.
The MG, with its strengths and weaknesses, has made the NHS sustainable and is still today an element of guarantee to allow its universality and fairness, even if certainly in the last two decades there seems to be a lack of a political interlocutor who wanted to enhance and invest in this sector.

What is certain is that MG has to change, to be honest it probably has yet to be born. In Italy we have tens of thousands of general practitioners who work with completely different organizations and performances, but it is not clear whether there is a MG understood as a homogenous area of ​​care characterized by defined skills and tasks.

It is evident, even to the most stubborn of conservatives, how a new model should be revolutionary on some issues starting from intra / interprofessional IT integration. It will also have to be stringent in order to clearly identify the competences and tasks that cannot be renounced for GPs in order to guarantee a homogeneous service throughout the territory.

A Convention that, after a gestation of forty years, lays the foundations for the birth of MG, starting from the foundations by clarifying tasks and functions, which will no longer be just the single “General Practitioner”, but the “General Medicine” of that territorial area; and that, for example, it identifies the basic associative forms (AFT) on which to graft the Community Houses, with an integrative function to the outpatient offer, where social and health services are provided.

Frankly, I think it is quite evident that the autonomous organization of general practitioners is the only way to guarantee that elasticity to the system that the public, due to the dynamics we all know, could never guarantee.
The reorganization of Continuity of Care could be a key tool to improve patient care in support of GPs and to reduce access to the ED.

A serious investment in training, which recognizes the mandatory training activity of GPs as paid “working time”, and new skills would allow the category to make an unavoidable professional leap forward. MG must become a university, not simply by having the university co-opt the training internship, but by evolving and acquiring the professional dignity to make MG considered a specialization in all respects and no longer the Cinderella of medicine.

A reflection should also be placed on the remuneration model of professionals, which cannot be limited to the Capital Quota, but must provide for a Variable Quota based on the organization, performance and complexity of the services provided, which is an incentive for the retraining and investment of professionals. on their profession and professionalism.
Without a shadow of a doubt, on the one hand, the shortage of doctors and on the other hand the increase in taxation, contributions and expenses related to activities determine a combination that is already making the profession of GP hardly attractive for young colleagues.

The PNRR creates the opportunity to invest in a structural way in the territory, but it would be a big mistake to make investments in structures without investing in the profession, since the general medicine of tomorrow, in addition to the structures, must first of all rely on culture, organization and vision of the future.

Otherwise, the discussion will be as light as it is unsustainable: the digital revolution is now underway, the pandemic has only accelerated it, the organizational models to ensure the proximity of treatments will inevitably have to take this into account.
The Metaverse awaits us dear colleagues …

Dr. Alessandro Bonci
General Practitioner ASL Toscana Centro
CDS Vinci Clinical Coordinator

November 03, 2021
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