Italy’s family doctors are intensifying pressure on regional governments to finalize the national collective labor agreement (ACN), warning that delays jeopardize the implementation of territorial healthcare reform. The Italian Federation of General Practitioners (FIMMG) has called on regions to act swiftly, emphasizing that without a renewed ACN, key components of the reform—including the rollout of Community Houses (Case di comunità), digitalization efforts and measures to improve the profession’s appeal—remain at risk.
The union’s appeal comes amid growing concerns over uneven progress in establishing Community Houses, which are central to Italy’s post-pandemic territorial healthcare strategy. Funded by the National Recovery and Resilience Plan (PNRR), these facilities aim to strengthen local healthcare by integrating general practitioners, specialists, nurses, and social workers in multidisciplinary teams. Although, reports indicate that many regions are struggling with staffing shortages and inconsistent service delivery, undermining the model’s effectiveness.
According to monitoring data cited by FIMMG, only a fraction of the planned 1,416 Community Houses are fully operational, with significant disparities between regions that previously experimented with territorial care models and those that did not. In Lombardy, for example, regional council reports showed that as of December 2024, only 130 of approximately 190 planned Community Houses were active, of which just 38 provided 24/7 coverage seven days a week.
FIMMG leaders argue that resolving contractual agreements is essential to ensure fair working conditions, adequate staffing, and sustainable investment in primary care. The union highlights that delays in the ACN renewal not only affect doctors’ morale and retention but also hinder the integration of services outlined in Ministerial Decree 77/2022, which defines the organizational standards for territorial care, including the Hub model of Community Houses.
The union has specifically urged regions to adopt the guidance act (atto di indirizzo) necessary to trigger the ACN renewal process. Without it, FIMMG warns, negotiations cannot proceed, leaving thousands of family doctors without updated contracts and slowing the deployment of digital infrastructure and team-based care models.
Beyond contractual issues, FIMMG has pointed to broader challenges affecting the attractiveness of general medicine as a career. Long working hours, bureaucratic burdens, and perceived lack of support have contributed to recruitment difficulties, particularly in underserved areas. The union stresses that addressing these concerns through the ACN is vital to securing a resilient primary care workforce capable of meeting the goals of the territorial reform.
Digital transformation remains another focal point of the reform, with plans to integrate Community Houses into regional appointment systems (CUP), enable electronic health record sharing, and expand telemedicine services. However, FIMMG notes that without clear contractual provisions supporting digital workload and training, implementation risks stalling.
The organization has also highlighted the importance of Functional Territorial Aggregations (AFT)—networks of approximately 20 general practitioners serving 20,000 patients—as a foundational step toward fully operational Community Houses. Regional leaders, including FIMMG’s secretary in Turin, Roberto Venesia, have suggested that strengthening AFTs could improve coordination and readiness for the Hub model.
As of early 2025, national monitoring reports on Community House implementation remain incomplete, with some regions lacking updated data. FIMMG has called for greater transparency and standardized reporting to assess progress accurately and direct resources where they are most needed.
The ongoing dialogue between FIMMG and regional authorities reflects a broader effort to align financial, human, and organizational resources with the objectives of Mission 6 of the PNRR, which aims to modernize Italy’s healthcare system through proximity, equity, and innovation. Stakeholders agree that success depends on resolving contractual uncertainties while ensuring that structural reforms are matched by tangible improvements in access and quality of care.
For updates on the ACN negotiation process and regional implementation of territorial healthcare reforms, readers can consult official communications from the Italian Ministry of Health and regional health departments.
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