Chapter 2

In this context, over the last decade three types of tools have been established for primary
care:
• of an organizational type, such as cooperative frameworks between GPs;
• economic-financial type, such as budgets and incentives;
• tools for professional promotion.
The following analysis will concentrate on the first two types of tools.
1.6.3 The organizational tools provided for by the regional agreements
To date, only a few Regions have stipulated primary care agreements, despite the deadlines
imposed by the National Collective Agreement (NCA) of 23rd March 2005 4 : Friuli
Venezia Giulia, Veneto, Toscana, Lazio, Liguria, Piemonte, Valle d’Aosta and Emilia
Romagna stipulated agreements between the end of 2005 and the first half of 2006, while
Abruzzo and Sardegnia reached a preliminary understanding.
Analysis of the recent regional primary care agreements, but also of those prior to the last
understanding, highlights that, of the tools available to GPs to guarantee demand control,
both those of an organizational and economic-financial nature play a fundamental
role, often being closely connected with each other.
The previous agreements had already identified cooperation as the most appropriate
form of reorganization of the primary care service: by strengthening the role of the GP and
making him/her an integral part of the structure and responsible for the process of identification,
direction and rationalisation of demand, the intention was both to improve the
quality of care offered to patients via greater flexibility in practice opening times and greater
availability of medical equipment, and to make systems for programming and control
of medical activity by the health authorities easier to manage, with doctors assuming
financial responsibility for the decisions taken 5 .
While the previous agreements identified – among the possible forms of cooperation –
GPs in association, general practice networks and GPs’ groups, the new agreements
focus attention on the strengthening of primary care guided by the most advanced forms
(for example the Primary Care Teams – Nuclei di Cure Primarie – NCP) in Emilia Romagna,
4 Six months for stipulation of the agreements plus a further three months if negotiations are already under way; once these periods
have elapsed, convocation is implemented at national level to conclude a substitute regional agreement which becomes binding
for the parties involved.
5 These forms of aggregation, documented by the Ministry of Health (2004), have never attained a level of integration (between
general and specialist physicians) comparable with the experience of other European countries (in particular, United Kingdom,
Holland and the Northern European countries) and have so far proved to be of little effect with respect to the objectives of
demand control and ongoing care, hence provision has been made at ministerial level for the development of new organizational
forms with budget responsibility such as the Community Authorities for Primary Care (Unità Territoriali di Assistenza
Primaria – UTAP) and, more recently, new multifunctional structures such as the “health centres” (Case della salute) referring
to the district and with a minimum catchment area of 20,000 inhabitants (in these structures the district technical-administrative
staff, the nursing staff, rehabilitation staff, social services staff, family doctors and out-patient specialists should work together).
Re. the most significant European experiences of cooperation between GPs, see Saltman et al. (2006).
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CEIS Health Report 2006