The Comptos Chamber yesterday published the Report on Citizen Accessibility to Primary Care (2018-2023), which “confirms” the “worsening citizen access to primary care” over the past five years. The report analyzes the 2018 to 2023, which include the two years of the pandemic that caused an “alteration of normal life and the activity of Public Administrations.”
Ignacio Cabezapresident of the Chamber of Accounts of Navarra, highlighted in the presentation that the main problem is “the lack of faculty staff”, which is evidenced by the impossibility of covering the absences of the professionals. These absences include vacations, days for private matters, paternity or maternity leave, or illness, among others.
In 2023, to cover the hours of absence from the position of all Primary Care staff 376 more full-time people would have had to be hired for a year. The days that each professional has available have increased in the period analyzed, specifically, the rate of absence from the workplace has gone from 18% to 21%. The degree of absence coverage in 2023 was 67%, compared to 76% in 2018, among which the reduction in family medicine (57%) and pediatrics (27%).
The first option to cover these absences is the temporary staff recruitmentwhich is complicated by the lack of available physicians in both medicine and pediatrics. In this way, they resort to carrying out extraordinary activity, “more expensive than that which has been allocated 19.27 million euros”, and temporary hiring, which has meant 61.36 million euros.
Increase in labor rights
Cabeza stressed that this situation will worsen in the next ten years with the Retirement of 787 workersof which 239 are doctors, 311 are nurses, 207 are administrators and 30 are pediatricians. In addition, the situation of family medicine doctors, whose average age is 52, is “particularly worrying.” Added to this is the fact that “Only 63% of family doctor positions are covered for MIR training and, of those that are covered, “only 50% then go to work or are working in the Navarrese Health Service”. Some “worrying gaps,” she said.
In addition, he added “the increase in labor rights of health personnel.” Thus, he gave as an example, in 2023, “the issue of the ‘gray-haired’, who are a increase in days due to seniority of vacations and own businesswhich causes these absences to have to be covered, with the problem that there is a lack of medical personnel to hire.”
On the other hand, the Chamber of Comptos concludes in its report that The number of patients per professional “is adequate”. In family medicine, physicians have 1,287 patients compared to the 2,000 maximum set by the regulations. In pediatrics are 882, while the maximum is 1,500. To the “increase and aging of the population we must add another factor that conditions the management of primary care: the increase in the average consultation time, which reduces the number of daily appointments.”
In this sense, last year it was agreed that family medicine physicians would attend to a maximum of 32 patients per day, spending from 10 to 12 minutes per consultation.” On the other hand, in pediatrics, the maximum was set at 24.
“We must work to increase the number of places in the Medicine course at the UPNA”
The president of the Chamber of Comptos, Ignacio Cabezacalled yesterday to “try by all means making the family doctor career attractiveto promote MIR places”, make plans “that allow attracting people” or retain those who study in the Foral Community, as well as increase the number of places in the Medicine degree at the Public University of Navarrea (UPNA) “within our possibilities”.
Regarding the last measure, he acknowledged that “it is quite complicated to provide infrastructure and supporting doctors. Medicine is not a normal career, requires a lot of support and a hospital behind for teaching purposes.”
Impact of the measures
Similarly, he requested that, when adopting measures “on labor rights”, It should be noted that the health service “is not a normal service for citizens” but rather a “basic service”. For this reason, he urged that “the effective impact of these measures be studied and what impact they will have on the life of the office, of the health center.” He made reference to the expansion of allowances and the reduction of daily care and stressed that “absences in other administrations delay the service and that’s it, but In Health they must be covered”.
The president of the Chamber of Accounts stressed that the lack of faculty personnel “It is not just a problem for Navarra, it is a state problem and a European problem”, which has caused the opening of “a fight between autonomous communities to attract the few doctors who want to work in the family sector and offer school places, housing or jobs for couples.”
42% of consultations are by telephone and 14% with more than a week of waiting
Last year there were “almost Five million consultations in Primary Care, 3% less than in 2018.” It is observed a Reduction of activity in family medicine and pediatrics10 and 17% respectively. The activity of the nursing staff, on the contrary, increases in both specialties, by 10 and 8% respectively. This is explained “by the increase in the roles of nurses in patient care.”
The report also analysed the evolution of waiting days to access primary care. In 2018, “71% of appointments were scheduled for the day they were requested or the following day”, and “only 4% of appointments were scheduled for a week or more”. Last year, appointments for less than two days “were reduced to 60%; those that are given for a week or more rose to 14%”.
In the period studied (2018-2023), The population with a health card has grown by 4% and reached 662,386 people, but this growth “has been uneven” because the stratum of population over 65 years old has grown by 11%“which is one of the populations that will have the greatest need for primary care.” In contrast, the population under 15 years of age has been reduced by 4%.
The president of the Chamber of Comptos also highlighted that the primary care consultation model “is being modified, giving greater presence to the scheduled appointment to the detriment of the daily appointment that is free and available to the citizen. Likewise, there is a rreduction of face-to-face appointments, “encouraging telephone appointmentsIn 2018, 72% of consultations were in person and in 2023 this was reduced to 58% and the remainder were made by telephone.
Spending on Primary Care increases by 33% in five years
Ignacio Cabeza praised “the economic effort that the Government of Navarra has made in the area of Primary Care” with an investment of “more than a billion” in this area in six years, “which has achieved a increase of around 33% in line with the increase in spending made by our Administration as a whole.”
Since 2018, the Government of Navarra has dedicated 1.083 million to primary care. In 2023, the average expense per person was 309 euroswith an increase of 28% compared to 2018. 84% of the expense is allocated to personnelwhich last year had around 1,800 professionals. Discounting their absences, the number of effective professionals remains at 1,400.
Spending has remained similar by health area, being 77% destined to the Pamplona area, 12% to Tudela and 11% to Estella. In the capital and its region there are 26 health centers and 27 clinics, which serve 57% of the Navarrese population.