The nurses are the largest group of primary care. Two years after the outbreak of covid-19, they feel that they have gone from being “applauded” to being “belittled”. David Oliver (Girona, 1965) is a nurse at the CAP Montilivi of Girona and delegate of the nursing union Satse.
How is primary care now?
After two years working in a pandemic, there is a lack of professionals and, above all, investment. Users cannot be served as they deserve. We have a lot of pressure, but we are who we are and there is a lot of work. Once the acute phase of the pandemic has passed, there is all the care for the diseases that have been left in the background and this means that we have the routine of the telephone interview. The user does not live too well.
Is there a lot of phone support?
A lot. In some CAP, it is very difficult for the user to go in person because we do not have hours left: we are who we are. The user comes to the CAP stressed, and this relationship between staff and patient sometimes carries a risk of verbal aggression. Also the user is burned.
“Once the acute phase of the pandemic has passed, the care of the diseases that remained in the background remains”
But the CAPs have recovered much of the lost presence.
Yes, he has recovered, but there is so much backlog… Chronic illnesses, diabetes check-ups, people who have to have check-ups, tests… All of that is recovering, but a lot of it is done by phone, the waiting list it is longer and with that the user does not agree too much. However, it is not the problem of the workers, we do our part. The primary budget does not even reach 17%, when it should be 25%.
How much of the CAP service is face-to-face and how much by phone?
There are no figures because it depends a lot on each CAP and the territory. There are templates that are better structured than others. Yes, I can tell you that by telephone we attend to what is not urgent. If it is serious, it is already passed to the emergency room and another type of attention is given. The programmed things are evaluated by telephone and then it is decided whether to act in person or by telephone.
How long does it take to give the patient an hour?
Often more than 48 hours, but it depends a lot on each basic area and the number of professionals they have.
“We attend to what is not urgent by telephone. If it is serious, it is already passed to the emergency room and another type of attention is given”
What is seen inside the CAP?
A lot of work to do, a lot of things behind schedule, there is once again a lot of difficulty with stable contracts. Personnel -particularly nurses- are rehired month after month and this has repercussions on user care. The system asks to recover the follow-up of chronic patients, still pending control, and with the staff we have, it is very difficult to attend to them in person.
Which CAP is worse in Girona?
In summer those on the coast: Blanes, Sant Feliu de Guíxols, Platja d’Aro… But all the CAPs have the same problem: there is no investment and that means that the basic areas have reduced their staff. And I can also tell you the same thing about all of Catalonia, they are the same everywhere: Lleida, Tarragona, Barcelona. There is a general discontent on the part of the professionals because two years ago we were applauded and essential, especially nursing, and we have come to be underestimated. There is no job improvement, we are working under the same conditions as 10 years ago, despite the fact that the agreements of the Catalan Institute of Health (ICS) and Siscat are being negotiated [el sector concertado]. This causes many people to leave the profession or go abroad.
Hello has given steps to strengthen the primary.
Yes, there were covid funds, but once the acute phase of the pandemic has passed, there are already instructions to hire less or hire for one or two months. But all this is structural. Improving the elementary budget should have been addressed years ago. They lack money, investment and professionals. In Catalonia there are six nurses per thousand inhabitants, when in Europe the average is nine per thousand inhabitants.
“In Catalonia there are six nurses per thousand inhabitants, when in Europe the average is nine per thousand inhabitants”
Is there a lot of territorial inequity?
Yes. But the main problem is the lack of professionals, including doctors, which makes nursing do tasks that do not correspond to them.
There are also closed local clinics.
In the local clinics there are nurses and doctors who depend on a CAP and do their homework in a town. With the covid, everything was concentrated in the CAPs and the offices were closed. But once the acute phase passed, due to lack of budget, due to lack of professionals, many have not reopened. Or, if they open, they do it two days a week, for example. In Catalonia, some 1,800 nurses have gone abroad in the last decade. We are all affected, but nursing -the most numerous group in primary school- is the most affected: we have borne the brunt of the pandemic, we have led vaccination.
Have they freed themselves from bureaucracy?
It is a theme that has always been. It has been discussed how it can be improved, but there is still a part that would be expendable. But this is a discussion that I don’t think depends on missing people, but rather it is a matter of how visits are scheduled. It should be a structural change of the primary in Catalonia. We would like to do much more user assistance and not so much paperwork or protocol.