Italy withdraws reform that would have put family doctors into public clinics
The Italian government has dropped a decree that would have integrated family doctors into taxpayer‑funded Community Health Houses, bowing to fierce opposition from doctor unions and internal rifts inside the ruling right‑wing coalition.
What the reform proposed
The shelved decree aimed to shift general practitioners out of autonomous contractual roles and into Community Houses (Case di Comunità), the maxi‑ambulatories financed with €2 bn of EU recovery funds (PNRR). Health minister Orazio Schillaci wanted at least a partial switch to employee status for the country’s roughly 37 000 family doctors, who currently operate as independent professionals under convention with the national health service. The urgency was tied to a hard deadline: by 30 June, at least 1 038 Community Houses must be functioning to secure the Brussels money, yet Agenas reports that only 4 % are currently operating at full capacity.
Blow‑up inside the majority
Doctor unions, above all Fimmg and the Smi, had threatened a national strike, while the social‑security fund Enpam – worth €32 bn – lobbied heavily. Forza Italia was the loudest political opponent, with leader Antonio Tajani warning the reform would turn trusted family doctors into “anonymous bureaucrats.” Giorgia Meloni eventually told Lombardy’s health chief Guido Bertolaso she could not push it through because of “too many contrasts within my coalition and too big a risk that citizens would see this as the end of the patient‑doctor relationship.” Lega and parts of Fratelli d’Italia joined the blockade, fracturing a majority whose regional governments had formally backed Schillaci.
Guido, I don’t feel like going ahead with it – too many contrasts among my people and too big a risk that it gets wrongly seen by citizens as the end of the trust‑based relationship with their own family doctor.
The moment of the stop
On 10 June the head of the health ministry’s cabinet, Marco Mattei, informed regional health assessors that the decree was being withdrawn. The text had been shared with the regions but never tabled in the Council of Ministers.
Bertolaso walks out
Guido Bertolaso, health assessor for Lombardy and the reform’s most vocal institutional champion, had travelled to Rome to convince the premier. After Meloni’s decision he resigned on the spot as vice‑coordinator of the Regions’ Health Commission, describing “immense bitterness.”
What happens now
The ministry insists that work on territorial medicine continues and will seek a new contractual agreement with GPs. The immediate compromise discussed is an obligation of six hours a week inside Community Houses, possibly inserted as an amendment to a government decree. The deeper reform – performance‑based pay, a university‑level specialisation equivalent for GPs, and a paediatrician up to age 18 – has been postponed.
As it was, the reform would have been a boomerang. Now we are ready to reason together.
