Miguel has been working during the covid-19 crisis in a Madrid hospital. Miguel is a pediatrician, he ends his residence this Tuesday and goes to another autonomous community: “Tomorrow I was going to unemployment. I wanted to stay here, in Madrid, in a hospital or in primary care, but the jobs they offered me were substitutions, days off, hiring me from Monday to Friday, unsubscribing on the weekend and rehiring me on Monday … Well, look, not”.
Of the 600 contracts that the Ministry of Health has announced several times that it was going to do to shore up primary care (PC), the mainstay for monitoring the coronavirus from now on together with Public Health, only 122 have been formalized, according to the data that offered the management of AP, dependent on the council, to unions last Friday. This is how Inma Martín, a nurse at the Nuestra Señora de Fátima health center in Carabanchel, and a UGT delegate, who was present at the telematic meeting held the same day that it was reported that the region was going to phase 1. From the counseling give another figure: “Of those who had at the beginning of the covid plan of reinforcement there were already 269 that remain. To this we must add 297 substitutions for temporary disability and increased working hours, plus another 270 residents who join as of June 1 ”.
“Substitutions for casualties and increases in working hours are no longer personal, they are professionals who cover others who are not. And the residents are not yet formalized, “explains Martín. In addition, to questions of this medium, the Ministry does not break down by categories or say which and in which areas are those 269 contracts that have been maintained since the beginning, nor does it provide exact data on the number of reinforcement contracts that have already been signed for the 10,167 that were to be extended and when these extensions are expected to be formalized. There was also no response on the temporary job board for toilets that opened for a few days last week.
“All they give is the possibility of contracts, and the possibility depends on the acceptance of those who are going to offer them,” the nurse insists on the residents. And it identifies as a clear problem the working conditions that are offered. “In many other regions they are much better,” he says. Castilla-La Mancha, Extremadura or Castilla y León offer better contracts, more stable and with higher remuneration.
Miguel [nombre ficticio a petición del pediatra] He is not the only one leaving, several doctors and nurses also have other autonomies for next year as their destination. “My contract is for a year with the possibility of expansion and with 30% more salary in Castilla-La Mancha”, explains this pediatrician, who “hurts” the situation in which health centers are seeing, about all now, “when they should be reinforced more than ever.”
On May 22, the effective reinforcement contracts that arrived for the covid-19 were seven doctors, 27 nurses and 16 nursing assistants, 15 administrative assistants, 11 guards and 46 drivers. “The rest, possible, future, but have not materialized,” adds Martin. Those “possible” are 10 extensions of the day [el suplente de un titular con reducción de jornada hace el 100% y el titular se mantiene con su reducción] in Family Medicine, 55 in nursing and three as technicians in auxiliary nursing care (TCAE), 14 in administration and one for caretakers.
Future contracts
They are also those who are currently covering a loss in the future. “If the holder is incorporated, the professional who is covering this temporary disability would be kept,” adds the nurse. These are 46 doctors, 120 nurses and 11 assistants, 80 administrative and 30 guards. Residents, 223 family doctors and 47 specialized nurses, “are going to be offered.” “But even they do not trust that they accept, they know that the conditions are dire, one week in each site,” claims Martín.
Cristina Sanz, one of those residents, rhetorically asks who is going to “want to have center-to-center contracts”: “They sell you that they will primarily try to get you to stay in two or three … It’s crazy, it’s very frustrating” .
Jesús Vázquez, assistant manager of primary care, was clear in a meeting with the centers’ directors last week. “He said that if more nurses had not been hired in the midst of a pandemic, although they were lacking, that it would not be done now. That is the interest,” says the nurse and UGT delegate Inma Martín.
In Madrid, the ratios of patients per primary care professional exceed national rates
In Madrid, the ratios of patients per PC professional exceed the national ones. According to the latest data from the Ministry of Health, as of December 2018, in family medicine the community has 1,557 patients per professional, 12.7% more than in the national calculation; 12.5% more in pediatrics; 25.4% more in nursing; 39.4% more in nursing assistants and 17.5% more in administrative assistants. Only those Balearic, Ceuta and Melilla ratios surpass, areas that usually find difficulties to contract due to their location. The calculations of professionals and unions is that in the region it would take 600 doctors, in a context without a pandemic, to enter the average.
Unmet needs
Now, in a crisis situation, the needs are greater, but they remain unresolved by the regional government. In addition to the previous commitments, the AP management wants to incorporate the 100 school nurses that end in June, with the school term, and 49 higher graduates during the summer [estudiantes de Medicina que no han pasado el MIR]. “These can go from support to residences, but nothing more. What is the summary? Adding up the contracts that have already been made and those that could be, the number of casualties that they say there are not even covered, more than 1,000, ”says Martín. That sum is 921.
Health in Madrid takes away resources from GPs while favoring private care
–Human resources are not the only problem. A doctor from a small health center in Madrid tells how the space they have does not allow them to do the double circuit and the cleaning problems: “There is supposed to be daily disinfection and there is not. For two weeks, I think, they have been looking at how they arrange the space to separate covid and non-covid patients, but it has not been solved yet. ” Its center, although small, remains open, but as of May 25, 65 clinics and health centers are still closed or semi-closed; and the Summa 112 keeps the emergencies closed at night and on weekends, after the reorganization of the primary school to refer professionals to the field hospital in Ifema.
“There are many problems that the primary is facing now,” summarizes Martín. Lack of swabs to do the diagnostic PCR tests or the implementation of the reinforcements in Public Health are another pair of them. Meanwhile, many of its professionals do not understand the present that this first step of the health system lives. Resident Cristina Sanz sums it up: “If it is not understood that the PA is essential, that it is health for 99% of the population, and it has to be a place where trust, continuity and longitudinality, local knowledge, and that this requires resources and end job insecurity, we are lost. ” She, this Tuesday, goes to unemployment. On principle, he says. “Because the contracts offered are unworthy, but not for me, but for the patients.”
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