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Spain, 2011-February one year since the formation of the “ primary care physicians Forum ” at the State level and encompassing scientific societies, professional unions and the Organization Medical College under an agreed programme of common objectives to promote the quality, equity, cohesion and the sustainability of national health, Madrid institutions signatory of this agreement (of primary care, Pediatrics and sindocatos professional scientific societies) system, we have decided to follow this line of action and to assume the same objectives, but adapted to the peculiarities of the health Madrid.

The main objective is the share, develop and maintain points of agreement to improve primary care Madrid and express them with a single voice on behalf of doctors in primary care.

We are all aware of the significance of our work for the society, with a high recognition and measurement, by what we believe our duty continue to pursue and ensuring the good evolution of this facet of health, pilar key of the same.

After the long existence of primary care and a proven quality in terms of values of efficiency, high capacity of resolution, good assessment by the assisted population and efficiency in the rational use of resources, should be a step more for natural leadership from primary carefocusing the health system on citizens and their health needs, with greater weight in the Organization and, as a result, a budgetary empowerment to maintain and improve our activity.

This forum of Madrid primary care doctors assumed as their own all the objectives set for months by the forum for primary care and be problems especially meanings in the community of Madrid, we want to start our journey by special effort on the following points.

The new organizational structure of the community of Madrid has not developed the functions of the Director of Health Center. If we assume that primary care should be the to centralize the functionality of the system, is a priority the accuracy of these functions within the also non-existent rules to regulate the functions of the health centre, for which we offer participation in this forum.

Secondly, it is essential to ensure the proper functioning of computer systems for the definitive introduction of the recipe electronic in the community of Madrid, measures that do not should focus exclusively on primary care, but at the same time spread to other areas of attention, bringing into line with recent government regulatory changes that unify the rules of prescription.

A great plague the A.P. has suffered in recent years is the excessive burden bureaucratic working and not strictly related to the functions of our profession. If we are to assume the leadership and the centralization of the system, you should remove this bureaucracy, and this would be the fourth point to develop.

Our efficiency in the rational use of resources is already known for, therefore a deviation. budgetary and other resources to the A.P. would give a break to a deficient system. Both the State Forum and we believe that in addition to ending the waste in the annual budget, it should be intended to achieve 25 per cent of the budget for primary care.

Sixthly, to promote the development of the A.P. Pediatrics must improve specific training of Pediatricians in primary care, respect of training official plans completed three months of mandatory rotation by health centres. They should promote the joint commissions of teaching Hospital-primary and accreditation of guardians of residents from paediatrics.

In seventh place, make a special mention to the instability of employment in primary health care Union agreements and firm commitments of public tenders for use on official documents adopted by the Government and the Assembly of Madrid that have not been completed to develop creating situations of excessive eventuality in places of scarcity of pediatricians and family medicine by emigration to other sites stable employment and remuneration, working conditions and professional more attractive.

With as regards the rules on existing temporary disability in the community of Madrid following the instruction of the Sub-Department of health care and that it is contrary to the Royal Decree 575/1997 of 19 June, is objective of this forum the fulfillment of the legality and the impulse of a new State regulation to simplify and improve the management of the temporary disability.

In ninth place want to take a reorganization of working time which gradually has been leaning toward the welfare work, oversize for the real needs of the population, to the detriment of other activities of our profession such as training, teaching, research and tutoring of resident doctors and/or medical students which results in benefits to the patient and the healthcare system. To achieve this, two things are necessary: the correct coverage of alternates and the increase in vacancies for doctors to get a suitable professional/population ratio. With the resource of the Administration’s lack of budget, other conditions of work and other types of reinforcement for professionals (assumption of bureaucratic burdens for other professionals, shift work, greater stability in employment, reorganization of pediatricians, etc.) could be improved

Along the lines of claiming to comply with formal agreements and the bet for the efficiency and rational use of resources, is required the full implementation of catalog of radiologic evidence for AP and working on getting a free access to all evidence radiologic from the physician primary care given that evidence from the health centres is not more or less expenditure of these resources and increase the capacity of resolution of the A.P. without unnecessary delays and delays that lead to other levels for diagnosis or problem-solving.

Finally, we believe that in recent years, the management structure of the SERMAS has undergone a progressive and little resolute politicization. demand the intervention of the doctors in management, planning and coordination of care activity, generating better care for citizens and professionals better care. It should not be forgotten that form any specialist doctor is a very high price to pay for our society, and this can not afford the luxury of losing them, infrautilizar them, or not to update their knowledge.