“We are not taking care of the patient as they deserve.”

Nurses are the largest group in primary care. Two years after the outbreak of covid-19, they feel they have gone from being “applauded” to being “belittled.” David Oliver (Girona, 1965) is a nurse at the CAP Montilivi of Girona and delegate of the nursing union Satse.

How is primary care now?

After two years working in pandemic, there is a lack of professionals and, above all, investment. It is not possible to attend the users as they deserve. We are under a lot of pressure, but we are who we are and there is a lot of work to do. Once the acute phase of the pandemic has passed, there is all the assistance of the diseases that have remained in the background and this means that we have the routine of the telephone interview. The user doesn’t experience it very well.

Is there a lot of telephone assistance?

A lot. In some CAPs, it is very difficult for the user to go in person because we have no hours left: we are what we are. The user comes to the CAP under stress, and this relationship between staff and patient sometimes involves a risk of verbal aggression. The user is also burned out.

But CAPs have regained much of the lost presentiality.

Yes, it has been recovered, but there is so much backlog… Chronic, diabetes controls, people who have to have controls, analytical tests…. All that is recovering, but there is a lot that is done by phone, the waiting list is longer and with that the user is not too much in agreement. However, it is not the workers’ problem, we do our part. The primary budget does not even reach 17%, when it should be 25%.

How much of the CAP care is face-to-face and how much by telephone?

There are no figures because it depends a lot on each CAP and the territory. There are staffs that are better structured than others. I can tell you that by telephone we attend to what is not urgent. If it is serious, it is passed to the emergency department and another type of attention is given. The programmed things are assessed by telephone and then we decide whether to act in person or by telephone.

How long does it take to give the patient an appointment?

Often more than 48 hours, but it depends a lot on each basic area and the number of professionals they have.

What do you see inside the CAP?

A lot of work to be done, a lot of backlog, there is again a lot of difficulty with stable contracts. Staff -especially nurses- are hired again month by month and this has repercussions on user care. The system asks to recover the follow-up of chronic patients, who are still pending control, and with the staff we have it is very difficult to attend them in person.

Which CAP is worse in Girona?

In summer those on the coast: Blanes, Sant Feliu de Guíxols, Platja d’Aro…. But all the CAPs have the same problem: that there is no investment and that means that the basic areas have reduced staff. And I can tell you the same thing about Catalonia, everywhere they are the same: Lleida, Tarragona, Barcelona. There is a general dissatisfaction on the part of the professionals because two years ago we were applauded and essential, especially nurses, and we have become undervalued. There is no labor improvement, we are working with the same conditions as 10 years ago, despite the fact that the agreements of the Institut Català de la Salut (ICS) and Siscat are being negotiated. [el sector concertado]. This makes many people leave the profession or go abroad.

Salut has given steps to strengthen the primary.

Yes, there were covid funds, but once the acute phase of the pandemic has passed, there are already instructions to contract less or contract for one or two months. But all this is structural. Improving the primary budget should have been addressed years ago. There is a lack of money, investment and professionals. In Catalonia there are six nurses per thousand inhabitants, when in Europe the average is nine per thousand inhabitants.

Is there much territorial inequity?

Yes. But the main problem is the deficit of professionals, also of physicians, which causes nursing to do tasks that do not correspond to it.

There are also local clinics closed.

In the local clinics there are nurses and doctors who depend on a CAP and do the work in a village. With covid, everything was concentrated in the CAPs and the clinics were closed. But once the acute phase was over, due to lack of budget, lack of professionals, many of them have not reopened. Or, if they do open, they do so two days a week, for example. In Catalonia, in the last decade some 1,800 nurses have gone abroad. We are all affected, but nursing – the most numerous group in primary care – is the most affected: we have carried the burden of the pandemic, we have led vaccination.

Have you freed yourselves from bureaucracy?

It’s an issue that has always been there. It has been discussed how it can be improved, but there is still a part that would be expendable. But this is a discussion that I don’t think depends on the lack of people, but rather on how the visits are programmed. It should be a structural change in primary care in Catalonia. We would like to provide much more user assistance and not so much paperwork and protocol.