Report Spain, October 2024

Since the last report submitted in April, there have been some important changes in the country's health current affairs in which the State Confedera on of Medical Unions (CESM) of Spain has been present and has con nued to work to demand the best working conditions for professionals. In May, the organiza on held its Confederal Congress in Murcia with elec ons that led to a renewal of the Permanent Commission and some Technical Secretariats, but the work has not been interrupted since then.

The new President of the CESM, Dr Miguel Lázaro from Balearic Islands and the new General Secretary, Dr Víctor Pedrera from Valencia Community, join us today in this assembly to meet the institution and the European colleagues of the federated unions of the FESM. In recent months, CESM has participated in the celebration of Primary Care Day to resume the demand for measures to improve the situa on of the first level of care, in which the mantra is repeated that there is a lack of doctors but where it has been seen that the real problem is that the solutions proposed by the Administration are not being well oriented.

Instead of improving the working conditions of those who practice in Primary Care - and in other deficit specialties - chooses to increase the places in the faculties of Medicine. It is becoming clear that every year there are Residency MIR places in Family and Community Medicine and Paediatrics that are not filled despite the increase in supply, so it is clear that it is not that there are no enough Primary Care doctors, the problem is that the necessary conditions do not exist for professionals to want to work at primary health level, which is increasingly deteriorating.

Shortly before the summer period, the Confederation continued to show its concern and rejec on of the state transfer of powers in the homologation of tles to the Autonomous Communities, warning of the danger that this represents for the principle of equity between territories. Work continued in the meetings of the Negotiation Area for the modification of the Framework Statute, in which CESM has always defended the need for a professional reclassifica on that differentiates doctors from other professional categories that are requesting their inclusion within the A1 subgroup. Regarding this reclassification, the Minister of Health herself has indicated that it must be done jointly with the Civil Service. CESM defends a specific statute for doctors that includes their peculiarities. The meetings were suspended for the holiday months, but they are pending to be resumed in September to close the revision of the Framework Statute.

In the middle of July, the Confederation celebrated the creation of the much-demanded specialty of Urgencies and Emergencies, which brings Spain closer to most countries in the European environment that had it recognized, although there are still some doubts about the itinerary to request it due to the requirements that have been established.

Also, in this summer period CESM has continued to ensure the rights of resident doctors, demanding that the regulations be complied with for residents in fourth year (R4) who exceptionally this year finished their residency in September because the 2020 pandemic delayed the start of their training. The ministry has also been asked to consider a change in the Residency MIR call for 2025 published in August - which again increases its offer of places, whose bases prevent those who finish their residency from being able to take the tests access again for just a few days, a change that Health has ruled out. However, the decision of the ministry to provide the necessary means to return to a real- me selec on of MIR places, as CESM had been asking for years, has been welcomed, thus reversing the measure that was unilaterally implemented due to the COVID19 pandemic to impose a solely telematic selection.

In these months it has also been necessary to publicly demand a solution to the critical situation that health is experiencing in the autonomous cities of Ceuta and Melilla, which depend directly on the Ministry of Health. These cities are not seeing their urgent demands met to provide decent care to patients and improve the particularly dire working conditions of professionals, despite the change that took place at the head of the public company INGESA and the commitment of the minister to mediate in the conflict, which has been going on for many months.

In addition, CESM has participated in the meetings of the Medical Profession Forum, which has presented its main objectives for the new course to the media, also in the Primary Care Forum and in the creation of the National Forum of Private Practioners.

For the next academic year, which is now beginning, the Confederation is actively working to launch a campaign demanding the full recovery of the extra payments cut over the last fifteen years and continues to work on crucial aspects for the medical community, such as the problem of aggression, which has increased especially in recent years and continues to increase. It also warns about the atiribution of medical competences to other professional groups and the problems in the quality of care that this entails.

Attention is also drawn to the unchecked growth of the demand for medical services and the violation of the regulations on occupational health, in which the Administration must be the guarantor and yet is the one that most violates the regulations. Finally, the working conditions, which include the anachronistic system of medical on-call services, which deprives doctors of the labour rights that are recognised for other groups and which CESM has asked to be thoroughly reviewed to see how it can be eliminated without it entailing a significant reduc on in pay. All these issues are on the Confederation's agenda for the coming months.