Satisfaction with primary health reform falls to 26% — see the reasons

A satisfaction of coordinators of Family Health Units (FHU) with the reform in Primary Health Care decreased five percentage points in the last year, from 31.9% to 26%, interrupting an improvement observed since 2022/23.

The data are contained in the report “The Current Moment of the Reform of Primary Health Care in Portugal 2025/2026” of the National Association of Family Health Units (USF-AN) which will be presented today in Gondomar, in the district of Porto, according to which dissatisfaction has risen from 43.7% to 46.8% and satisfaction has decreased from 31.9% to 26.0%.

In statements to the Lusa agency, the president of the USF-AN and coordinator of the study, André Biscaia, was not surprised because when there are no improvements, “satisfaction begins to fall”.

“ Computer glitches are something that really upsets everyday life. We also had a large increase in the [users’] lists. Now the lists, in generic terms, are much bigger than they were. And practically only [users] users, therefore, the workflow is very intense ", exemplified André Biscaia.

Remembering that the FHU teams lack professionals such as psychologists, nutritionists, physiotherapists, social workers, among others, the leader said that “the nuclear family health team [doctor, nurse and clinical secretary] is required to do all the roles”.

“ Clearly, they can't always do it right. It is required to adapt when everything else has not adapted”, warned.

Still regarding the “pressure on the teams”, 85.0% of the FHUs confirmed absences over 30 days.

According to André Biscaia, cases such as pregnancies, long-term illnesses and people displaced to other services are included in the prolonged absences, and the President insisted: “All this then overloads the rest of the elements of the units.”.

The report is based on the responses of 541 coordinators of the 712 USF existing at national level at the time of the study, i.e. 76% of the total.

Highlighting that to this study contributed “the largest number of respondents ever”, the USF-AN specifies that the data were collected between June 19th and August 4th this year and were invited to participate all USF coordinators. There are currently 717 FHUs.

The study also concludes that the FHUs where respondents work are the most valued structure, with 74.9% of coordinators satisfied or very satisfied with the activity of the FHU itself, however, less 5.7 percentage points than in the previous year.

As for central structures, the USF-AN analysis points out that “no one achieves a positive balance”: “The Ministry of Health, the Executive Board of the SNS [National Health Service], the ACSS [Central Administration of the Health System] and the SPMS [Shared Services of the Ministry of Health] concentrate levels of dissatisfaction between 65.6% and 71.3%”, reads the report.

On the other hand, the clinical directors for Primary Health Care, as well as their assistants, are the best evaluated governance structures, “while the ULS [Local Health Unit] as a whole maintains a positive but fragile balance.”.

“ This means that the closer the leadership, the greater the satisfaction. This assessment that coordinators make is not a generalised bottom-up. It is directed to where there are problems and a greater distance. When there is more proximity, when there is more inclusion, satisfaction increases ", analyzed André Biscaia.

To Lusa, the president of USF-AN highlighted this report, which goes in the 16th edition, a new area analyzed, dedicated to rural USF.

For 87.4% of the coordinators of these FHUs, the indicators currently used penalize rural FHUs. Lack of transport is considered the main barrier of access for users.

As regards measures to establish professionals, the specific remuneration incentive (65.4%), the increase associated with rurality (48.8%) and the adjustment of the size of the lists (45.7%) are indicated.

“FHUs are being established, not in the Seaside and in the large centers, but in the interior and in areas with low population density. These FHUs have special needs”, said André Biscaia.

The association calls for a legislative change to recognize some territorial differentiation, that is, that the Deep Alentejo is not treated in the same way as a Lisbon neighborhood.

“ Both have problems and are different problems that cannot be addressed in the same way ", defended.

In the report it appears as a proposal to introduce the principle of Territorial Differentiation into the legislation of the FHU, with workload metrics, indicators and incentives adjusted to the geographical dispersion and aging of populations.

“A professional who is always in the same USF, as is, for example, my case, has different difficulties than one who has to distribute by one or two poles or make a home where he may have to walk 30 or 40 kilometers. This is one of the aspects that is really limiting the increase in the number of FHUs in these areas with less population density,” she said.