GP role within the referral system Counter-referral to patient and/or GP

GPs main feautures GPs and paediatricians are self-employed professionals working with the Italian NHS upon a National contract plus a regional and local integrative agreements; GPs have to guarantee: medical consultations, either at the physician’s office or at the patient’s home, residential nursing homes and emergency cases for their patients; prescribing medications, integrated care, diagnostic tests and laboratoryanalyses; referrals for hospitalization, including day treatments/elective surgery; services that require a health professional to administer care (e.g. sutures, injections, intravenous injections); flu vaccinations during vaccination campaigns aimed at targeted population groups at risk.

Main issues Need for GPs to go beyond their traditional gate-keeper role for hospital and specialist services to take on a greater role in coordinating strategies to deal with chronic and degenerative diseases (Chronic Care Mode); managing the growing complexity of diagnostic and ambulatory (outpatient) services (lack of integration with ambulatory specialists, no standardized guidelines nor outcomes monitoring of GPs activity); playing a greater role in health promotion strategies.  No formal PHC equipes  No university degree required in family/community medicine to practice;  No explicit definition of PHC services in the national essential levels of care (LEAs) ( Corsalini e Fattore, Mecosan 2012; 82: 61-75).

Policy efforts Encouraging the institution of Primary health centres (Case della salute) to overcome solo- practice; Improving ICT systems to facilitate outpatient- inpatient information sharing; Definition of clinical pathways, GPs and specialists’ role witching the pathways and patients referrals.  Important regional differences

Pending policy questions in Primary care What payment arrangements for the new Primary health centres (Case della salute)? Payment schemes: what mix of pro-capita and clinical pathways outputs/outcomes? How to shift part of GPs remuneration towards équipe activities?