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Feature Covid-19

Primary care in Spain: underfunded, understaffed, and neglected

BMJ 2022; 379 doi: (Published 29 November 2022) Cite this as: BMJ 2022;379:o2665
  1. Aser García Rada
  1. Madrid
  1. alphaborealis{at}

The covid pandemic has exposed the state of primary care in Spain. Doctors say the country must finally face up to long running problems, including a lack of permanent employment for health workers. Aser García Rada reports

Spain’s covid-19 pandemic put intensive care units1 and nursing homes2 in the spotlight. But during the first wave in 2020, it was the country’s 3000 primary care centres and 10 000 local doctors who managed 90% of the covid-19 infections.

In 2020, they attended to 2.3 million covid-19 patients and followed up with another 5.3 million close contacts.3 While hospitals performed 72.7 million consultations that year, primary care centres dealt with more than quadruple that figure: 379 million consultations, which was 12.3 million (3%) more than in 2019. Teleconsultations increased by 600% to 127 million and home visits by 4% to 13.5 million—all while these services also fulfilled their role in covid-19 vaccination.

The strain has widened the cracks caused by years of budget cuts after the 2008 financial crisis, from which Spanish primary care has never recovered.45

In a bid to woo voters, “throughout Spain and regardless of which party was in power, investing in primary care was stopped to invest in [secondary care] instead,” says Francisco José Sáez, family physician in Arganda del Rey and coordinator of the management section of the Society of General Practitioners and Family Physicians (Sociedad Española de Médicos Generales y de Familia).

Two and a half years of covid-19 have brought to the surface over a decade’s worth of underlying problems in an overburdened primary care system whose professionals feel exhausted and frustrated.6

State of the nation

Spaniards wait an average of nine days to see a primary care physician, compared with six days in France or four in Germany (in both cases, according …

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