Primary care in Italy & CVD (2017)
As of December 31, 2016 Italy had 60,589,445 inhabitants, more than 5 million of whom had foreign citizenship: 8.3% at national level. The decrease in the number of births that started in 2008 was still going on. In 2016 children born were less than half a million, just over 69,000 of which were foreign (14.7% of the total). Compared to 2015, there was an overall reduction of 12,000 units (2,700 for the foreigners).
The deaths were over 615,000, almost 32,000 less than in 2015. The decrease in 2016 was due to a high level of mortality registered in the previous year. Approximately 70% of the deaths are due to tumors or circulatory diseases.
Italy is characterized by one of the highest rates of population ageing in Europe and at global level. 21.4 percent of the population is 65 years and older. In this age group, 3 percent are older elderly people, i.e. aged 85 years or more, and of these 16,390 are over hundred-year-old.
Over 8 million people – i.e. almost 15% of the total population - suffer from at least one serious chronic illness. This prevalence is strongly increasing with age and reaches 50% in those aged over 80 years.
In Italy there are about 47,000 general practitioners (GPs) and 13,000 non-stop assistance physicians. GPs are freelancers under contract with the National Healthcare System and therefore are self-employed and not in the employ of the NHS.
Every citizen has the right to freely choose his own GP and can change his choice at any time. As a result of these choices, each GP has a list of patients. The maximum number of patients for each GP (the so-called ceiling) is 1,500 people. In Italy every GP has on average 1100 adult patients (aged over 14 years).
To access General Medicine, a specific training certificate in general medicine is required. This specific training is represented by a three - year practical and theoretical course carried out at regional level, at the end of which a general-practice certificate is issued for the exercise of general medicine under the NHS.
According to the National Collective Agreement between the Regions and the trade unions, GP’s surgeries are open at least 5 days a week (but in many cases even on Saturday morning for at least 2 hours), and ensure availability throughout the day from 8am to 8pm.
From 8pm to 8am, non-stop assistance physicians operate, guaranteeing home and outpatient care in assisted structures during night times, pre-holidays and public holidays. A non-stop assistance physician is foreseen every 5,000 inhabitants.
In recent decades, GP's activity has been evolving from “solo” work to teamwork, through participation in associative forms of general medicine and the use of surgery’s staff.
More recently, a reorganization of the primary care system has been introduced. The Regions should define the organization of local services through the establishment of single-specialization teams, consisting of just GPs, and multi-specialization teams, which shall provide medical care through the coordination and integration of GPs, other professionals in the area (paediatricians), nurses, midwifery, medical technical staff, rehabilitation staff, prevention and social staff.
Teamwork and professional integration should provide a more complete and qualified response to the needs of the population, operating on a 24/7 basis.
The proportion of GPs who understand and fluently speak English is very low, and is below 10%.
