Primary care cries out for reinforcements in the face of its extreme situation

Pepa López gave birth by cesarean section on August 6 at the Maternal and Child Hospital of Malaga, but for the removal of the stitches - an appointment stipulated in 10 days - she called and called without success until on August 22 she went to her center Pigeon Shot's health score after a claim for the delay.

It was late.

“A staple got up and stuck in, which gave me an infection from not having removed it in time.

I got a fever and passed out.

And they wanted to send me home, due to the risk of covid, without removing the stitches, until they came to their senses ”.

López's bitter episode reflects the deterioration of primary care that has dragged on for years and which the pandemic has caught in its infancy and shivering.

After a summer in which the 13,000 health centers have assumed the burden of the hospitals at the beginning of the crisis, the waits have skyrocketed and a first appointment can take up to 15 days.

General practitioners, 26,000 in Spain, warn that they are at the limit and are unable to treat all suspected cases of covid and their mild, chronic or multi-pathological patients.

They fear that the healthcare pressure will worsen with the fall, the drop in temperatures and the rise of infectious processes.

The scenario is paradoxical in health centers.

It's bustling outside, queues at the entrance are long, and patients complain that service is poor.

Inside there is more silence, fewer patients to respect the safety distance and the doctors and nurses work piecework with 30% more cases - most of them by telephone -, according to the scientific societies.

Vaccines, laboratory extractions or cures have fallen unevenly, but in all communities.

The primary care forum, which brings together the Collegiate Medical Organization and scientific entities, exploded last Monday in the face of "the disaster": "The coronavirus is only anticipating the end, it is giving the finishing touch to primary care."

“I have had peaks of 60 patients a day and I come home to go to bed.

We work with a terrible feeling of fear of making mistakes and we are so sad that we hardly protest ”, says Susana Aldecoa, president of the Galician Association of Family and Community Medicine (Agamfec).

From Madrid, the pediatrician Concha Sánchez, president of the Association of Primary Care Pediatrics (Aepap), denounces that her "insufficient" 10 minutes per patient has now fallen to three.

“This morning, up to 90% of my patients are demands from the asymptomatic population due to lack of organization, for hiring few trackers.

We cannot attend to our patients apart from the covid ”.

An average one-year-old child catches between eight and 10 infectious processes each winter.

"We are shivering and the cold has not started," illustrates Salvador Casado, a primary school doctor in Soto del Real.

Yesterday in the queue to enter the El Alamillo health center in Seville, Estela Castro lamented: “It's fatal.

They do not attend and I have been waiting two months for a cytology that cannot be delayed.

The other day I left because the queue went around the building ”.

That neglect that is palpable at street level also has figures: in Castilla-La Mancha, the 746,447 telephone calls to its health centers in July 2019 (60% attended, 440,000) rose to 2.7 million last year June, but the number of people attended was one million, 38%.

“More work is being done despite the fact that the population feels that they are not being cared for well”, says Natalia Vallés, Manchego's general director of Primary Care.

In early summer, when the curve was down and the second wave seemed far off, there was consensus on the key to curbing the virus.

“Everyone agreed, health economists, managers and public health workers agreed that we had to bet on primary care.

And in September we verified that these resources are very scarce and after the accumulated fatigue the level of evident tension begins ”, summarizes Salvador Tranche, president of the Spanish Society of Family and Community Medicine (Semyfic).

"Yesterday for example I had 57 patients, 30% more than usual," he says.

The pressure is greater in regions with a high rate of covid infections such as Madrid, Catalonia, the Basque Country or Aragon.

“Well, well, there is no autonomous community that is doing it.

If primary care, which is the basis of the system, does not have the necessary templates, for many hospitals and ICUs that are set up, this does not go ahead ", censors Vicente Matas, member of Primary Care at the Colegio Medico Organization.

And the fall?

“It is difficult to predict because the scenario is changing, but in the southern hemisphere the incidence of flu processes has been lower due to masks and hand washing.

Measures must be implemented to transmit health education.

Every winter we repeat this self-care work over and over again and we cannot reach the people ”, Vallés claims about public awareness that could partly prevent collapse.

A plan on deaf ears

A year and a half ago, the Ministry of Health launched a plan to reform primary care together with the scientific societies and experts of each autonomous community, but it fell on deaf ears.

“From this strategic framework, without an economic memory, nothing has been done, absolutely nothing.

Neither the Ministry nor the 17 communities.

Nothing is nothing, ”criticizes Tranche.

The Minister of Health, Salvador Illa, admitted in the Senate last June: "We have to promote primary care, strengthening its structure and resources."

The unions and scientific societies demanded 4,000 million from the Government and the communities before the pandemic for health centers and estimated a deficit of 4,600 doctors.

This level of care has always been at the bottom of the list in the priorities of the National Health System.

Public investment has fallen 388 million in a decade (from 10,775 million to 10,387 in 2018), according to data from the Ministry of Health.

And for every thousand inhabitants there is an average in Spain of 0.77 general practitioners, when the European is 0.9.

The presence of these doctors ranges between 1.11 in Castilla y León and 0.62 in the Balearic Islands or 0.68 in Madrid, both at the bottom of the country.

The exhaustion of doctors and nurses will translate into mobilizations by territories.

In the Basque Country, the unions have called a demonstration in Bilbao on October 3 and in Madrid on September 28 primary care is called to strike.

With information from

and

Medical appointments with delays of up to 15 days

With the meager workforce depleted by summer vacations and casualties, uncovered for years, GPs now have to combine the tasks of tracking and monitoring those infected by the covid with all their consultations, including those accumulated during the state alarm.

The consequence is that patients take between 8 and 15 days to get an appointment by phone, in which the doctor decides whether they should be seen in person.

This avalanche of work is now joined in regions such as Catalonia by medical support for nursing homes, and at the beginning of the school year, also care for schools and institutes to control the pandemic in the classroom.

“I have been in a situation for many years and I have never experienced a situation with such helplessness,” explains Mari, a nurse at a CAP in Barcelona.

It summarizes the stress and fatigue of professionals due to "endless schedules, especially telephone, and equipment depleted because some are dedicated almost exclusively to doing PCR."

The Metges union recalls that since the cuts in the previous crisis, the primary care system has lost 900 doctors in this region.In Andalusia, the threat of mobilizations in white coats is a ghost that has loomed over the last year and to which the Board fears.

“We know that 36 years [of socialist government] cannot be changed in two days, but those two days are almost two years.

We are at the limit ”, censors Fernando Ramírez, a primary care physician in Sanlúcar de Barrameda and spokesperson for Basta Ya Cádiz.

"We agree that it is necessary to improve public health, for that reason and for that we are working," responds a spokeswoman for the Ministry of Health and Families.

In six years, 30% of Andalusian family doctors will retire. The Minister of Health and Families, Jesús Aguirre (PP), a family doctor, repeated his anecdote shortly after taking office: “When the internship students came At the end I asked them: 'What color was the patient's eyes?

If they didn't know, he would kick them out of the office.

We must remove bureaucracy from doctors so that they dedicate all their time to the patient ”.

After a year and a half of management, nothing has changed for Andalusian doctors and those 10 minutes have even diminished to 5 minutes, denounces the College of Physicians of Seville.

Information about the coronavirus

- Here you can follow the last hour on the evolution of the pandemic

- This is how the coronavirus curve evolves in Spain and in each autonomy

- Download the tracking application for Spain

- Search engine: The new normal by municipalities

- Guide to action against the disease