Call to Action for a Quality Rural Health Service in Castile & León

In recent years, the National Health System in the rural areas of Castile & León has been progressively dismantled. In view of this, we are making a call to halt the removal of basic health services.

In November 2019, the Department of Health of the regional government (Junta) of Castile & León (Spain) approved the New Model of Health Care in Rural Areas. In this restructuring plan for health services, it is clearly stated that the objective is “to transform the organizational dynamics and clinical model of Primary Health Care in the rural areas of Castile & León”. In short, this model aims at centralizing material and professional resources, eliminating regular consultations at local clinics in small villages.

This means that thousands of small villages that currently have weekly consultations with a doctor and nurse will be left without them, and thousands of local clinics will therefore be completely DISMANTLED.

At the same time, two new types of institutions will be created: the Rural Grouping Clinic, with daily consultations, and the Proximity Clinic (in towns with larger populations), where medical consultations are by appointment only. It should be stressed that the driving time from any locality to the nearest Rural Grouping Clinic would be at least “30 minutes”. If we add that the rural population is generally older than the population of urban areas, and that it has no local public transport or other means of moving from place to place, getting to a general practitioner for a consultation becomes a truly dramatic affair.

Finally, one aspect of the restructuring proposed by this model is the introduction of a system of prior appointments with telephone screening, or medical consultation by telephone to assess a patient’s condition. These options are not valid for most of the elderly population, and we request their withdrawal.

The platform for rural health care therefore calls for the following:

• The repeal of this model and any other that upholds the same principles.
• To ensure unconditionally and on a national scale that local rural clinics remain open, guaranteeing the presence of doctors and nurses at least once a week in every clinic, regardless of the local population.
• Immediately fill the posts of health care professionals assigned to each Basic Health Zone, guaranteeing that services are covered during holidays, leaves, shift work burnouts, etc., and scale human resources in accordance with the demographic and territorial needs of each region.
• To improve the range of services provided by all clinics and supply them with the necessary and sufficient human and material resources.
• To equip rural areas with a 24-hour ambulance service and a paediatrics service for children under 14.
• To improve working conditions for health personnel in order to attract them to the rural areas and the so-called ‘Empty Spain’, especially to towns where coverage is difficult.
• To eliminate telephone screening, which is a barrier to Primary Health Care. Tele-medicine is not a quality health care option, and should be restricted to the exchange of data between professionals.

With this call, we are saying:

• STOP the dismantling of the Rural Health Service,
• STOP the growing insecurity of life in the countryside,
• STOP (forced) depopulation,
• STOP the lack of services.

Health is a right, and if the COVID-19 pandemic has taught us anything, it is that work in the countryside is essential for the nation’s food supply. In other words, the rural environment is a source of food and sustenance of life.

To maintain rural life, we need a rural health service of respectable quality.
Support this initiative on behalf of rural health care!
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www.sanidadrural.es