Family Doctors 2.0 for a breakthrough in crowded emergency rooms

Bringing together political forces, citizens, institutions and stakeholders around a table to discuss the country's health problems and find concrete solutions.

This is the goal of Motore Sanità's 2023 Summer School, now in its tenth edition, which concluded today in the municipality of Gallio, in the province of Vicenza. This flagship event in the Italian healthcare sector focused on the necessary reform of community healthcare in one of its sessions.

Spotlight on the family doctor 2.0 and on the Aft (Territorial Functional Aggregations) configured as Spoke Health Houses, to be located in the immediate vicinity of emergency rooms, manned by family doctors, white coats of the medical guards and nurses equipped with level I technologies, with which to act as a real filter for improper access to hospital and emergency rooms of chronic patients and patients affected by comorbidity, saving on the Pnrr funds to be used and invested to create Long-term care beds in which Italy is at the bottom of the class in Europe behind even countries such as Spain, Sweden and Portugal.

A NEW CARE MODEL

The new care model of family medicine is a proposal to review care in the territory – explains Silvestro Scotti, national secretary of Fimmg – it is a project we have been working on for two years, also presented to the former minister Speranza and to the Draghi government even if not publicly.

And now to be integrated with the reform projects that are being discussed in the State-Regions Conference and in Parliament. We are talking about the strengthened, revised and corrected version of the Aft (Territorial Functional Aggregations) planned by the regulations but never fully taken off, which are also configured as a spoke articulation of the Health Houses financed with EU funds from the Pnrr but without a certain staff allocation”.

ENPAM FUNDS

In the background is Enpam, the doctors' welfare agency, which owns properties throughout Italy and which has decided to allocate ad hoc funds specifically to co-finance the AFTs that have been strengthened and renamed as Community Homes spoke for the care of chronic conditions, making use of office staff and nurses.

“A model of assistance – explains Claudio Zanon from the Motore Sanità Summer School which in Gallio in the province of Vicenza has collected proposals from all the regions for a realistic proposal for the reform of local medicine - that if the project is also located near the main emergency rooms, it would save resources to be used for Long Term Care hospital beds that Italy urgently needs to align itself with the offer of the main European countries, provide free first level diagnostic tests (spirometries, ECG, laboratory tests), decongest specialist levels and reduce waiting lists and that with the telemedicine system it will also be possible to take advantage of the advice of online specialists without counting the wide possibilities of implementing prevention projects on a large scale with vaccinations (flu, covid, herpes, pneumococcus), screening (breast, colon, pap test, hcv, finger prick on site and in case of positive results, activation of the ASL prevention departments”.

SPOKE COMMUNITY HOUSES

Spoke community homes in which doctors with white coats of continuity of care would maintain the employment relationship, ensuring updating and modernization of existing AFTs with about 4/5 doctors even in the countries of the disadvantaged internal areas that do not have hub community homes in any case designed to serve a catchment area of ​​50 thousand inhabitants and instead with the guarantee of proximity of the family doctor. In practice, from the Summer School a real proposal for the revision of the Ministerial Decree 77. "Let's not throw away the money of the Pnrr - concludes Zanon - and let's use it to increase the supply of beds for chronic and non-self-sufficient patients as happens in other European countries, including Spain, Sweden and Portugal".

“Enpam will finance the restructuring and strengthening of the AFT (Associazione famiglia delle famiglie territoriali), defining what will be the future Spoke health homes. News that was already partly announced a few days ago. This is because doctors continue to say that they do not want to go to the Hub health homes, some of which have already been built and are still empty, as foreseen in DM77.

This is due to the fact that the DM77 was written in a health emergency situation, without involving the directly interested health workers and citizens and without having been examined by the Chamber and the Senate of the Republic. This means that what was built could have been built uselessly.

Let's stop, because in reality the Spoke community homes are being outlined and will take the name of what were previously the AFTs and instead we are going to use the money to build what distances us from the rest of the Western world, that is, beds for long-term patients, which are absolutely insufficient because the RSAs and home care cannot make up for this shortage that clogs up the departments, which does not allow the Emergency Departments to be emptied and increases the waiting lists. Let's therefore use the money from the PNRR to make these chronic long-term care facilities, possibly close to the hospital incorporated into acute hospitals to make economies of scale, especially with regard to human resources, using for example nursing staff who will be essential in the management of long-term patients in private practice and under the responsibility for example of general medicine or internal medicine divisions that will have to take care of these patients using other specialists when necessary. If we don't do this, we won't get out of it. Let's make a change to the money of the PNRR on the DM77. We have never been hospital-centric, we have reduced the beds for acute cases, other countries have done it too, we more than others, but the others have diversified by significantly increasing the beds for long-term patients, even in Spain and Portugal and Sweden where there are community homes. We have not done it".