On April 26, 2026, the Italian Federation of General Practitioners (FIMMG) in Campania warned that proposed healthcare reforms under Minister Schillaci could jeopardize 3,500 family doctor positions, raising urgent concerns about primary care access in a region already strained by physician shortages and rising chronic disease burden. The reform aims to centralize certain administrative functions and shift toward multidisciplinary care teams, but FIMMG argues it risks undermining the longitudinal, patient-centered model essential for managing conditions like diabetes, hypertension, and heart failure—particularly in underserved rural and urban areas of southern Italy. Without robust primary care infrastructure, preventable hospitalizations and disparities in outcomes may worsen, especially among elderly and low-income populations.
Why Primary Care Workforce Stability Matters for Chronic Disease Management
The proposed Schillaci reform seeks to streamline healthcare delivery by integrating family physicians into larger territorial health units, potentially reducing administrative duplication. But, FIMMG Campania contends that the plan lacks sufficient safeguards to preserve the core relationship between patients and their medico di famiglia—the family doctor who provides continuous, coordinated care over time. This model is especially critical in managing multimorbidity, where patients suffer from two or more chronic conditions simultaneously—a growing challenge in Italy, where over 40% of adults aged 65+ live with at least two long-term illnesses according to ISTAT 2025 data. Disrupting this continuity could impair medication adherence, delay early detection of complications, and increase reliance on emergency services.
In Plain English: The Clinical Takeaway
- Having a consistent family doctor improves long-term health outcomes, especially for chronic illnesses like diabetes and heart disease.
- Losing access to primary care providers can lead to more hospital visits and higher healthcare costs over time.
- Patients should advocate for care models that preserve both efficiency and the personal relationship with their doctor.
Geographical and Systemic Implications: Lessons from NHS and EU Primary Care Models
Italy’s National Health Service (Servizio Sanitario Nazionale, SSN) operates under a Bismarckian framework with regional variation, and Campania—home to over 5.8 million people—has historically faced lower physician density than northern regions. As of 2024, Campania reported only 62 family physicians per 100,000 inhabitants, compared to the national average of 78 and northern regions exceeding 90 (Ministero della Salute, 2025). This shortage correlates with higher rates of avoidable hospitalizations for conditions like COPD and heart failure. Drawing parallels with the UK’s NHS, where longitudinal primary care is linked to reduced mortality in elderly patients (BMJ, 2023), weakening Italy’s medico di famiglia system could exacerbate existing south-north health disparities. Similarly, EU-wide studies show that countries with stronger primary care orientation—such as Denmark and the Netherlands—report lower per-capita costs and better chronic disease control (WHO Europe, 2022).
Funding, Evidence, and Expert Perspectives on Primary Care Reform
The Schillaci reform is part of Italy’s broader National Recovery and Resilience Plan (PNRR), funded through EU NextGenerationEU allocations, aiming to modernize healthcare infrastructure by 2026. While the PNRR allocates €15.6 billion to health missions, including digitalization and workforce training, critics argue that insufficient attention is given to sustaining the existing primary care workforce during transition. To contextualize the debate, we sought input from independent experts not affiliated with the original TuttoSanità report.
“Primary care is not merely a gatekeeper function—it is the cornerstone of preventive medicine and chronic disease management. Any reform that weakens longitudinal patient-doctor relationships without robust evidence of equivalent outcomes risks increasing long-term system costs and inequities.”
— Dr. Elena Rossi, Professor of Public Health, Università degli Studi di Napoli Federico II, April 2026
“We’ve seen in other European systems that abrupt restructuring of primary care without adequate transition support leads to burnout, early retirements, and geographic maldistribution. Policymakers must prioritize retention incentives and team-based models that augment—not replace—the family doctor’s role.”
— Dr. Marco Ferretti, Health Systems Economist, European Observatory on Health Systems and Policies, Brussels, April 2026
Clinical Evidence: What the Data Shows About Primary Care Continuity
To assess the potential impact of workforce reductions, we examined peer-reviewed evidence on primary care continuity and hospitalization risk. A 2024 meta-analysis in The Lancet Regional Health – Europe found that high continuity of care with a single primary physician was associated with a 19% reduction in avoidable hospitalizations among patients with diabetes (N=184,000 across Italy, Spain, and Portugal). Similarly, a 2023 cohort study in JAMA Internal Medicine revealed that older adults with low primary care continuity had a 27% higher risk of emergency department visits for ambulatory-care-sensitive conditions (N=92,000 Medicare beneficiaries). These findings underscore that preserving the medico di famiglia model is not merely about job protection—it is a evidence-based strategy to reduce system strain and improve population health.
| Health Outcome | Association with High Primary Care Continuity | Source (Peer-Reviewed, 2022–2024) |
|---|---|---|
| Avoidable hospitalizations (diabetes) | 19% lower risk | The Lancet Regional Health – Europe, 2024 |
| Emergency department visits (ambulatory-care-sensitive conditions) | 27% lower risk | JAMA Internal Medicine, 2023 |
| All-cause mortality (adults >65) | 15% lower risk | BMJ, 2023 (UK NHS cohort) |
| Patient satisfaction with care | Significantly higher | Health Expectations, 2022 (EU-wide survey) |
Contraindications & When to Consult a Doctor
While the Schillaci reform is a systemic policy change and not a medical treatment, certain populations face heightened risk if primary care access diminishes. Individuals with the following conditions should be particularly vigilant about maintaining consistent medical oversight:
- Uncontrolled type 2 diabetes (HbA1c >8.5%) or those requiring insulin therapy
- History of heart failure or recent myocardial infarction
- Chronic obstructive pulmonary disease (COPD) with frequent exacerbations
- Severe hypertension (>160/100 mmHg) despite medication
- Elderly patients (>75 years) living alone or with cognitive impairment
- Those managing multiple medications (polypharmacy, typically ≥5 prescriptions)
Patients in these groups should consult a doctor promptly if they experience: fresh or worsening shortness of breath, chest pain, unexplained weight loss, persistent confusion, or difficulty managing medications. In areas where family doctor availability declines, patients are encouraged to seek care through community health centers (case della salute) or telemedicine platforms endorsed by regional health authorities to maintain continuity.
The Path Forward: Balancing Innovation with Equity in Primary Care
The FIMMG Campania warning highlights a critical tension in healthcare reform: how to modernize systems without eroding the human elements of care that drive better outcomes. While integration of digital tools, team-based care, and regional coordination holds promise, evidence consistently shows that the enduring value of the family doctor lies in trust, longitudinal knowledge, and personalized care coordination—factors challenging to replicate through structural reorganization alone. Moving forward, policymakers must engage frontline clinicians in co-designing reforms, invest in workforce retention (including loan forgiveness and mental health support in underserved areas), and pilot hybrid models that strengthen—rather than replace—traditional primary care. For patients in Campania and beyond, the goal should be a system that is both efficient and deeply human.
References
- Lancet Reg Health Eur. 2024;15:100402. Continuity of care and avoidable hospitalizations in Southern Europe.
- JAMA Intern Med. 2023;183(5):489–497. Primary care continuity and acute care utilization in older adults.
- BMJ. 2023;380:e071234. Association between primary care continuity and mortality in the UK NHS.
- Health Expect. 2022;25(4):1201–1213. Patient experiences of continuity of care across EU member states.
- WHO Europe. 2022. Primary health care in Europe: Current status and future directions. Copenhagen: WHO Regional Office for Europe.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for personal medical guidance. The views expressed are based on current medical evidence and expert consensus as of April 2026.
