In the end, it was the center-right that stopped a reform that had been born within the same majority. After weeks of negotiations, pressure, and growing tensions with family doctors’ unions, the government decided to abandon the decree law on territorial medicine. In the background remain the deadlines of the PNRR and the issue of Community Houses to be made operational, but the case mainly revealed deep divisions within the center-right, leading to an open clash with some Regions and the harsh reaction of Lombardy’s welfare assessor, Guido Bertolaso.
A REFORM THAT WILL NOT SEE THE LIGHT
The territorial medicine reform promoted by Health Minister Orazio Schillaci has been officially shelved in its original version. The project envisaged a comprehensive intervention on the role of general practitioners, intended to impact the organization of territorial assistance and the functioning of Community Houses financed by the PNRR.
The most controversial point concerned the transition to employment status for a limited number of family doctors and specialists, currently contracted with the National Health Service (SSN) as freelancers. The goal was to ensure stable personnel in the new territorial structures, especially in areas where it is more difficult to cover services. The draft also contained other measures, such as specialization in general medicine and a revision of the organizational models of territorial assistance.
THE GOVERNMENT’S STEP BACK
The decision to halt the decree was communicated to the regional health assessors by the chief of staff of the Ministry of Health, Marco Mattei. Instead of the reform, the aim is now a much more limited solution, which should be included in the agreement with family doctors or introduced through a legislative amendment.
The hypothesis currently on the table, writes Il Sole 24 Ore, consists of the obligation for general practitioners to work at least six hours a week in the Community Houses. This measure is considered necessary to ensure the presence of professionals in the structures that must meet the targets set by the PNRR by the end of June. According to ministry sources, the goal of strengthening territorial medicine and ensuring the presence of doctors in the Community Houses remains unchanged, even if through different tools than those initially planned.
DIVISIONS WITHIN THE CENTER-RIGHT
The most significant aspect of the affair concerns the political level. The reform had been developed by the Ministry of Health with the support of the Regions and had found particular backing in administrations led by the center-right, such as Lombardy, Lazio, and Veneto. Despite this, the project progressively stalled within the same majority that had promoted it.
According to Sole, the pressure exerted by family doctors’ unions contributed to changing the political balances. Forza Italia reportedly opposed the employment hypothesis from the start, a position later aligned with by the League and members of Brothers of Italy. In this context, there are also rumors that Prime Minister Giorgia Meloni invited Schillaci to slow down the reform process.
BEHIND THE SCENES AND SCHILLACI’S ISOLATION
The backtrack highlighted Schillaci’s political isolation. Repubblica tells of a minister determined not to abandon the project and convinced of the need for a structural reform to give a future to the Community Houses. “I will go ahead. The reform will not stop because it is needed by the citizens,” he reportedly confided to his collaborators.
The minister himself reportedly emphasized that the problem does not only concern the professional status of family doctors but the entire model of territorial assistance. “The reform is mainly for the Community Houses, we must not focus on the status of family doctors,” is one of the reflections attributed to him. However, the growing opposition within the majority and the lobbying action exercised by the unions progressively reduced the political space to proceed with the decree.
THE PROTEST FROM LOMBARDY
The harshest reaction came from Lombardy. During the meeting with the ministry, regional Welfare assessor Guido Bertolaso expressed “deep dissent and immense bitterness” over the decision to shelve the reform.
Bertolaso, reports Repubblica, left the table announcing his resignation from the role of vice coordinator of the Health Commission of the Conference of Regions. The Lombardy assessor had been one of the main supporters of the project and considered a broader intervention necessary beyond the mere obligation of six hours in the Community Houses. “We worked three months on the text, we all agreed. It is a disheartening affair,” he reportedly said during the discussion with ministry representatives.
THE UNIONS’ EXULTATION…
The stop to the decree was welcomed by family doctors’ organizations, which had contested the method followed by the government and especially the employment hypothesis. The secretary of the Italian Federation of General Practitioners (Fimmg), Silvestro Scotti, stated that “as it was, the reform would have been a boomerang, now we are ready to discuss together.” The Italian Doctors’ Union also asked to open a new discussion on the agreement and the organization of work in the Community Houses.
…AND THE OPPOSITION’S ACCUSATIONS
The reactions from the opposition were opposite, reading the withdrawal of the measure as the result of an internal war within the majority. “A reform announced as decisive is withdrawn because Brothers of Italy, Forza Italia, and the League fought among themselves,” declared PD deputy Ilenia Malavasi, while senator Sandra Zampa, head of the PD group in the Health, Social Affairs, and Labor Commission, denounced the exclusion of Parliament from the reform discussion, asking for clarifications on the reasons that led to its shelving.
The position of the Five Star Movement parliamentarians in the Social Affairs Commissions of the Chamber and Senate was also harsh, who spoke of a “commissioned minister.” According to the Five Star representatives, the internal clash within the majority risks compromising the path of strengthening territorial healthcare and leaving the Community Houses built with PNRR funds understaffed. The M5S also accused the government of not allocating sufficient resources for personnel and of turning the dialogue between the ministry, majority parties, and Regions into “a disaster for citizens.”
