“It is impossible to make a comprehensive assessment [of these two years] because there are many differences from unit to unit. This was expected to happen. The realities are very distinct. It starts right away because our coverage by family doctors is very asymmetrical. This alone causes very different integration in various places,” evaluated the president of APMGF.
In an interview, on the eve of the National Health Service (SNS) completing two years of national coverage in the ULS model, Nuno Jacinto recalled the primary healthcare sector’s great fear when this reform was announced, of being overshadowed by hospital care, and was direct.
“In some places, this was avoided, in others not. The difficulties are not the same. In many locations, the benefit of this new operating model may not have been proven, and there may even be situations that have become more complicated than before, particularly in terms of internal process management, supply, human resources, information systems. In others, indeed, there may have been gains and improvements,” he described.
Diagnosing by regions, without delving into specific cases, Nuno Jacinto pointed out that “in Lisbon and Vale do Tejo, where family doctor coverage is lower, there have obviously been many more difficulties.”
However, the opposite is not entirely obvious: “On the other hand, in the Northern region, we knew that due to an already strong primary healthcare structure, many administrative procedures, human resource supply, bureaucratic processes were already more refined, and with the transition to ULS those difficulties intensified.”
And the president of APMGF added a third reality to the list of asymmetries: “In university ULSs, which are very large, there are greater difficulties, and therefore a USF [Family Health Unit] or a UCSP [Personalized Health Care Unit] is clearly more lost in the midst of that institution than it would be, for example, in a ULS in Alentejo or Trás-os-Montes.”
Emphasizing that the assessment cannot be homogeneous, Nuno Jacinto has one certainty: “The difficulties may be related to local realities, but the country must find a path regardless of political cycles.”
Since January 1, 2024, Portugal has been entirely covered by 39 ULSs, in a reorganization announced with the objective of facilitating people’s access and their circulation between health centers and hospitals.
The ULSs integrate hospitals and health centers under a single management.
In parallel, the Regional Health Administrations disappeared.
During this period, the SNS Executive Direction had three executive directors and the country different legislatures.
“One of the things we repeatedly say in the association is that we need a direction. I’m not even talking about the long term, but at least in the short and medium term. We need some consistency. We said from the beginning that the ULSs, from a theoretical point of view, have their virtues. But guidelines, follow-up, some boundaries are needed, and paradoxically, greater autonomy for each board of directors, precisely to give relevance to both primary health care and hospital care,” analyzes Nuno Jacinto.
Boards of directors “without autonomy for basic things,” development and organization plans that “take a long time to be approved,” staffing maps “to be approved or outdated” are, according to APMGF, “just some of the enormous management difficulties,” something that “obviously discourages professionals,” he added.
“There is no real follow-up. There are some scattered things, but there is no moment when we all sit down and ask: ‘So, what are your difficulties in your locations?’,” said Nuno Jacinto, posing a challenge.
“Let’s pause a bit, sit at the same table, if necessary even for several days. Everyone: the guardianship, boards of directors, professionals, and answer ‘what is important? What is needed to solve this?’. We cannot always be running and inventing solutions on the fly, creating disconnected measures,” he concluded.
