A new Primary Care: Key transformation points in the national collective agreement for the 2019-2021 triennium

The new National Collective Agreement introduces many elements of innovation and changes in the role of Primary Care and its positioning within the “system of care” of territorial care. Three key aspects aim to better connect andintegrate Primary Care with the entire network of services: (i) organizational forms (Unità Complesse di Cura Primarie and Aggregazioni Funzionali Territoriali); (ii) connection/integration with Community Health Centers; (iii) establishment of the Unified Primary Care Role.These aspects of reorganization will have to be coordinated with the forecasts of the PNRR and DM 77/22 and the necessary construction of new structures that will also involve the Local Health Organization.The Authors, also on the basis of their experience and knowledge of the field, examine these issues to define the “crucial nodes” of this process of organizational and professional regeneration that, disengaging itself from ideological schemes and models (dependence, physical presence, etc.), identifies a path of construction of a new network for territorial care.These reorganization aspects must be coordinated with the provisions of the PNRR and DM 77/22, and the necessaryestablishment of new structures that will also involve the District. The authors examine these issues to reflect on the new role and functions that Primary Care in Italy must assume during this process of organizational and professional regeneration that, disengaging itself from ideological schemes and models (dependence, physical presence, etc.), identifying a path of construction of a new network for territorial care.It is at present difficult to be able to say how much of the hypothesis of a “systemic” approach to General Practice, will be realized given this recent innovative pathway. Collaborative negotiation, correspondence of Hub and Spoke Community Houses (CdCs) with UCCPs and AFTs, Specific Training for AFT-Referrers and UCCP-Coordinators, regional policies shared with territorial arrangements and needs, could at this stage initiate and foster this virtuousprocess of chancing management for the construction of a new network of Territorial Primary Care and with it of Italian General Practice. On the contrary, self-referential regional negotiation, differentiation of Hub and Spoke CoCs with UCCPs and AFTs, identification of Referents/Coordinators for only a “representative” role, regional policies on directional CoCs and/or inconsistent with territorial assets and needs, could introduce rigidities that could prevent or slow down the development of this process.

Keywords: Primary Care Organization; PNRR; Collaborative Network; Community Houses; Professionalism

Massimo Magi, Luca Del Bene, Una nuova Medicina Generale: i nodi della trasformazione contenuti nell’Accordo Collettivo Nazionale per il triennio 2019-2021 in "MECOSAN" 132/2024, pp 73-96, DOI: 10.3280/mesa2024-132oa20679