The first of several doctors' strikes took place this week as a result of an ongoing conflict over medical staff's dissatisfaction with the Health Department's failure to act on their demands for improvements to the Andalusian Health Service (SAS).
The aim of the stoppages, which GPs and paediatricians throughout the province of Malaga were urged to support, is to jolt the health authority into action and start to rebuild the public health service to provide better healthcare for the local population.
The strike was called by the medics' union Sindicato Médico de Málaga (SMM) and the protest group Basta Ya, which is formed by around 300 primary healthcare doctors (GPs and paediatricians) and has the support of the Colegio de Médicos (official medical association).
Their demands include the recruitment of more medical staff for health centres in the province of Malaga (the SMM claims that 150 more GPs are needed and 50 more paediatricians), job stability with long-term contracts, at least ten minutes appointment time for each patient (now the average is six) and salaries in line with the Spanish average (Andalusian doctors earn 600 euros less than the average).
They are also calling for more security in health centres in light of the increase in cases of violence against professionals, more freedom to prescribe medication, to be able to order more diagnostic tests for patients with a waiting time of no more than 30 days for the results, and for health centres to have more autonomy to manage themselves.
The strike comes after months of unrest among healthcare professionals which reached boiling point after a summer described as "disastrous" by Basta Ya. The protest group decided at a meeting in September that indefinite partial stoppages were the only solution and agreed on the strike dates with the doctors' union.
"The situation is unsustainable. The summer has been bad due to the lack of locum doctors being taken on [to cover holidays]. The SAS has taken no notice of our requests. Doctors are starting to feel exasperated. The strike is the only way out and the way to make the authorities see our discontent," the Basta Ya spokesman Carlos Bautista told SUR.
The president of the union SMM, Antonio Martín Noblejas, stressed the significant deterioration that primary healthcare in Andalucía has suffered in recent years.
"The SAS hasn't known how to sow seeds to reap rewards. The staff increase that the regional Health Department has announced is good, but we believe we need more doctors, because there has been a huge deficit in Malaga for years," said Martín Noblejas, who added that around 800 primary healthcare GPs and 400 hospital doctors have signed a document in support of the demands made by the union.
The president of the Colegio de Médicos, Juan José Sánchez Luque, said, "The strike responds to the feeling of impotence among staff at primary healthcare centres and the increase in cases of assault on professionals this summer. We have to find urgent solutions to the problems." The medical association is in favour of a second reform of primary healthcare.
According to the SMM's delegate for primary healthcare, José Antonio Becerra, what GPs want is to be able see their own patients without also having to take on those of absent colleagues who have not been substituted, which means a lack of time to provide a decent service.
"We have to be able to devote an average of at least 10 minutes per patient and each doctor shouldn't have more than 1,500 patients in his or her care; the average is currently around 1,700," said Becerra.
The regional Health authority has announced a series of improvements included in what it calls its primary healthcare renovation strategy, however these have been deemed insufficient by doctors.
The plan includes, among other measures, an increase in the staff in the province's health centres of 282 workers, of whom 64 would be GPs and nine paediatricians. The recruitment will take place between October and December, the jobs will be long-term and add to the 88 new staff contracted last year. The new recruits promised for health centres will also include 124 nurses, three midwives, 12 physiotherapists, five social workers, 29 porters/drivers, nine radio-diagnosis specialists and 21 administrative assistants.
The director of the Málaga-Guadalhorce health district, José Luis Gutiérrez, told union representatives that before 1 November there will be commissions set up to assess and manage the demands of each health centre. He added that 95 per cent of appointments made by patients are "satisfactory". "This means that the service is not overflowing," said Gutiérrez.
Delays for patients
Primary healthcare doctors consulted by this newspaper said at the end of last week that they would go on strike to make the Health Department see how disillusioned they feel with their profession and let down by the authority.
"I don't care about the financial side. If I have decided to go on strike it's because of the deterioration that the health centres have been suffering for years," said one GP. Another point that concerns the professionals is the delays patients have to put up with when referred to specialists.
"In August I referred a patient to a traumatologist and they've given him an appointment for December. That is a four-month wait when really he ought to be seen within a maximum of 60 days," said another doctor.
This same professional also referred to patients who have had to wait eight months for a colonoscopy and when the test was carried out they were found to have colon cancer.
"We can't allow this to happen, nor can we allow a year's wait for an electromyography (EMG) or six months for an ultrasound scan. These delays are past tolerable," he said.