STA, 22 March 2019 - Threats by dozens of general practitioners around the country to quit in the face of a recent decision to increase the number of patients GPs are expected to cover have been making headlines in recent days. Matters seem to be spiralling out of control, as medical students have also been showing no interest to pursue a career in general practice.
While tensions over increasing red tape for GPs and their general workload have been mounting for years, the situation seems to have escalated as a result of the financing and organisational plan for public healthcare in 2019.
The plan, put forward by healthcare purse manager ZZZS and confirmed by the government, raises the permitted number of patients per GP. The increase also affects health centres that have been performing above that national average, which has been scrapped as a reference point.
More Slovenian doctors start to protest
The first to protest were 21 doctors in Kranj, who already stopped accepting new patients in February. They also addressed a letter to Samo Fakin, who in the meantime resigned as health minister due to ill health, in which they threatened to quit by the end of March.
All of the 15 GPs at the Celje Health Centre issued a similar threat earlier this week, while three doctors at the Nazarje Health Centre have already resigned.
Moreover, on Thursday doctors at the Ajdovščina Health Centre, which has seen a number of retirements in the recent period, announced they would no longer perform overtime work.
Doctors' organisations are demanding solutions that will allow GPs to do their job in line with professional standards. They say that the recommended patient index is 1,500, that the currently valid ceiling is 1,895, while the actual Slovenian average stands at 2,406.
However, the ZZZS argued that enforcing the ceiling would mean 325,000 people in Slovenia remaining without primary healthcare.
A threat to the constitutional right to healthcare
"Every stakeholder in the system shares some responsibility for solving this problem together. It however cannot be solved in the way proposed by some doctors, by starting to reject patients at 1,895, since this would even violate the constitutional right to healthcare," the ZZZS said.
Solutions highlighted by the ZZZS include appropriate education policy planning, meaning securing enough GPs, and a reduction of administrative burdens. It is also looking for ways to secure more funding.
"The management of health centres also have a number of tools at their disposal and can above all use reallocation to secure a more equal distribution of burdens among doctors," the ZZZS wrote.
There are currently 950 GPs in Slovenia along with 315 GP trainees and according to February data, the workload of 42% or of 595 family and children's doctors did not exceed the Slovenian average.
The Health Ministry, which is being run temporarily by Prime Minister Miro Šarec since Fakin's resignation, says it is drawing up measures that will resolve things in a systemic manner.
It announced fewer administrative tasks, a new financial model for primary healthcare that will be stimulative, and a call for applications for 80 to 90 GP speciality training spots in this year.
Healthcare in Slovenia faces growing problems
The problem however is that interest for a career in general practice has been very modest. Only 13 application were filed for 64 spots made available in a call last spring and eight in the autumn call that offered 60 spots.
What is more, health centres did not manage to find new GP staff even though additional funding had been secured for the purpose.
The head of the family doctors' trade union Praktikum, Igor Muževič proposed the impasse could be bridged with the inclusion of foreign doctors. He however added that no dialogue exists between the union and decision makers.
The situation was meant to be discussed today by the parliamentary Healthcare Committee, but the session was cancelled because it was not certain the representatives of the Health Ministry would be able to attend.
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