Govt moves to appease doctors
The new standard was set at per-head index of 1,895, a figure that shows the workload taking into account the number of patients and their age and which translates into 1,383 patients.
The per-head index is set as the upper level, meaning that GPs would be allowed to turn away any new patients once they have reached the level. However, the new norm would be phased in gradually.
Speaking after the government session on Thursday, Health Minister Aleš Šabeder said the decision did not mean that doctors would be able to cancel patients that have already chosen their GP.
He said the partners involved in talks committed that no insured person should lose their chosen GP.
Those changing residence or moving from paediatricians to GPs will be temporarily assigned to the GPs with the lowest number of patients, until new GP teams are added to the public health system.
Šabeder said new patients would first need to be accepted by those below the 1,895 index or 1,383 patients, or the teams (doctor and nurse) with the lowest number of declared patients in each unit.
The GP teams in the units above the agreed norm but below the national average of 2,436 per-head index or 1,778 patients, will need to take new patients temporarily, but no more than the national average.
The same index does not necessarily mean the same number of patients per doctor because younger patients have lower index than older ones, who as a rule see the doctor more often.
The new standard was formed as an annex to the general healthcare agreement for the year.
The agreement set the per-head index at average per unit of the health insurance institute ZZZS, which in most busy areas only increased the workload.
Under the collective bargaining agreement, the index for this year is 1,895, but the ZZZS has been insisting that meeting it would mean hiring at least 300 more doctors.
Instead, the ZZZS proposed for the index to be based on the national average, like in the past years, which currently stands at roughly 2,400.
While previously recalcitrant, the ZZZS said today the government decision was final and had to be respected by all stakeholders in healthcare.
The index or ceiling adopted by the government is the same as the one set down for the year in the agreement signed between the trade union of doctors FIDES and the government after the 2016 strike.
The agreement also envisaged that the ceiling be reduced by 5% each year to the target index of 1,500, as set down by doctors in a 2008 document called the Blue Paper.
At the beginning of April, the FIDES union announced that doctors will start working strictly by the agreed workload standard on 1 June.
In protest at excessive workload, GPs in some of the community health centres have started giving in their notices or threatened to quit.
The first to hand in their resignations were 24 doctors at the Kranj Community Health Centre, whose notice periods will expire at the end of this month. The per-head index there was 2,700.
However, as the doctors took leave massively in order to use it up before their notices expire, this led to a chaotic situation at the Kranj centre after Labour Day holidays as many of the doctor offices were closed.
Šabeder said the solution adopted today was "the first step to resolving the GP issue and the first step on the long and thorny path of urgently needed changes in the Slovenian health system".
He expects the GPs will now withdraw their resignations, although he is aware the solution will not tackle the work overload problem at once, but only in the coming years.
Šabeder said that funds for new GP and paediatric teams for this year had already been ringfenced, but had not been spent yet due to staff shortages. He promised new measures to follow soon.
Kranj GPs welcomed the new standards as a step in the right direction, but are yet to decide whether they will withdraw their notices. They are to make their decision known on Friday.
Igor Muževič, the president of Praktikum, a trade union representing GPs, likewise said the move was a step in the right direction and a message that doctors' workload would not increase indefinitely.
"It will prevent the current system from falling apart. We know that it was not possible to do more than this in this time frame," he said.
The president of the Medical Chamber, Zdenka Čebašek-Travnik, also welcomed the government's decision, calling it a brave move and the first signal that Health Minister Aleš Šabeder had understood doctors' messages. She said it was however only the first step towards improving the situation in health.
The move was also hailed by the Association of Health Institutes, which said it welcomed any solution that would contribute to stabilising the situation in primary healthcare.
However, the association also warned that the annual 5% decrease of the workload as agreed with FIDES was not viable, because it would mean hiring 500 more GPs by 2024, which was impossible given the shortage of doctors and lack of interest of trainee doctors to specialise as GPs.