The study titled “The Current Moment of Primary Healthcare Reform in Portugal 2024/2025”, conducted by the National Association of Family Health Units (USF-AN) and released today, indicates that about 60% of health center coordinators believe their teams (including nurses, clinical secretaries, and doctors) are complete, although shortages are more evident in less densely populated areas.
The report states that 81% of the Family Health Units (USF) experienced prolonged absences, and in most cases (58.2%), the replacements were handled solely by team members. In 9.2% of cases, external professionals were used, and in one-third of the units (32.6%), a mix of both internal and external resources was necessary.
In the majority of cases, it was particularly necessary to replace doctors, with minimal occurrences of replacing other professionals. Data show a slight improvement in the situation since 2020/21, but on average, there is still a shortfall of one professional from each group agreed upon within the USF.
This shortage is most notable among doctors, followed by nurses and then clinical secretaries. “Currently, we have very large patient lists as well as frequent users, meaning those who use the service extensively,” stated André Biscaia.
In addition to consultations, professionals engage in significant non-face-to-face activities, such as answering emails, taking phone calls, writing reports, and issuing chronic prescriptions, summarizing: “Sometimes, non-face-to-face activity is double the face-to-face work.”
The size of the patient list is another priority highlighted in the study, which notes that the high patient load per doctor is “one of the largest obstacles” to providing quality care, contributing to professional ‘burnout’.
Many units believe the current size of patient lists – a result of the law governing USF – as well as “constant pressure from health authorities and Local Health Units (ULS)” to increase these lists, lead to exhaustion and a decline in care quality, thus reducing motivation and the number of professionals willing to work in the National Health Service.
Regarding careers, over 90% of USF agree on the establishment of a superior clinical secretary career, and the study highlights difficulties in opening recruitment processes for specialist nurses and in certifying competencies in family health nursing.
In light of these findings, the authors suggest formal compensation mechanisms for prolonged absences and overtime (in 55.7% of USF, work beyond the official schedule is not considered for future compensation).
In the improvement map crafted by this study, the USF-AN also proposes establishing a pool of service providers within the ULS (encompassing hospitals and health centers).
As an example, it notes that some ULS (particularly in the North and Center) have already opened processes to fill a pool of family doctors to address prolonged absences, recommending similar actions for other health professions.
The study is based on responses from coordinators of 538 Family Health Units, which represent 77.6% of the USF at the start of the study. Data were collected between July and September 2025.
Top priorities identified by coordinators include reconciling activities within the USF with personal/family life and implementing policies that prioritize primary health care and improve interoperability between software programs within the USF.
