Mega-aggregations (also extra contract) are against doctors, against patients and not an offer of quality.

In Italy, a not-elected and financial technocratic Government is trying to impose by diktat and without any discussion with doctors many new duties, as well as considering the birth of new mega-aggregations of professionals and practices covering large extensions of population and working 24 hours on 7 days as family medicine.

The reaction from GPs' associations is strongly negative in this very bad period of crisis without contracts, without money and with only dismantling ideas for the NHS. They see this as a disruption of trusts' power in micro groups, as a problem for patients obliged to walk or travel to distant and big buildings (who pays for them ?) where they will get long waiting lists, confusions of different people and doctors, duplication of exams.

The Government's indication seems similar to the proposal of “ Polyclinics “ in United Kingdom, but also without any funding in this case.

Claire L Morgan and Hendrick J Beerstecker (1) indicate that there is no evidence to suggest that very large practices could provide or are providing more volume or diversity than the current average English practice.
Therefore, a policy to create larger practices may not automatically lead to a transfer of work from secondary to primary care.

This is only the last and just aborted input for new “ governances “ for Family Medicine (2), coming bottom-down, not agreed by primary care (3), by secondary care, by patients themselves (data for disagreement by Italian national statistic questionnaire where the GP-patient relationship is still seen as the “ must “) but pushed by the politicians because of their economic interests and not considering what Family Medicine was, is and will be, anyway (see the WONCA European Definition of Family Medicine and the specific core competences of Family Medicine for all European Countries).

Francesco Carelli
Professor Family Medicine University of Milan
EURACT Council Director of Communications
Email : carfra@tin.it

REFERENCES
1. CL Morgan, HJ Beerstecker. Practice size and service provision in primary care: an observational study. Br.J.Gen.Pract., 2009, 59: 186-190.
2. Department of Health . Implementing care closer to home: convenient quality care for patients. , Part 1: Introduction and overview.
3. Www.unionemedici.it. Reaction to pre-aggreement on a new contract with mega-aggregations. 2009

Competing interests: None declared