Will there be a shortage of nurses, midwives in primary health care (PHC)?

The recent alarming news about the shortage of nurses and midwives due to their acquisition of pension rights has not yet made its way through the media. And there has been further alarming news in connection with regulations that come into effect on January 1, 2025, according to which patients' statements of intent will lose their validity. The October 27, 2017 law on primary health care, will also introduce funding changes to the primary care model.

The regulations indicate that the POZ team will be made up of a doctor, a nurse and a midwife, and that the entire pool from the capitation rate will go into a common fund. - We have very many signals that the implementation of these regulations means the loss of the possibility to choose a nurse and a midwife in POZ. By choosing a doctor, the patient, as it were, automatically accepts his colleagues. Nursing and midwifery practices after January 1, 2025 have no possibility of continuing to operate. There are no specific criteria and rules on which they are to cooperate with POZ doctors. Physician entities employ nurses and midwives on their premises, who provide their services mainly on-site. It is worth noting that the majority of patient care services in the patient's home are provided by nursing and midwifery practices , which under the new regulations are de facto left without funding," says Mariola Lodzinska, president of the NRPIP.

The consequences are easy to predict: patients requiring the delivery of health services provided by nurses and midwives at home will be left without services, and a multitude of nurses and midwives will be left without jobs.

The professional nurses' and midwives' self-government asked the Minister of Health to work out the principles on which cooperation between medical entities
and nursing or midwifery practices is to take place.

- It is necessary to define these rules. We asked the National Health Fund in September 2023 how the establishment of the POZ Teams will be verified, and under what formal rules they are to be established. We did not receive an answer. Medical entities should be required to cooperate with nursing and midwifery practices. Nurses and midwives directly employed by medical entities will continue to provide health care services in offices, rather than in home settings, on doctor's orders. What means of communication will be made available to the various members of the POZ team providing health care services (POZ doctor or POZ nurse and midwife practices), and will rules for cooperation between them be established, taking into account the different organizational forms of health care providers? Will it be possible to establish principles of cooperation in the form of a cooperation agreement between individual providers, as defined in Article 11( 2 ) of the above-mentioned Act, i.e. a POZ doctor, a POZ nurse, a POZ midwife, if so, what necessary elements should such an agreement contain? Will POZ nurses or POZ midwives engaged in professional practice, who, for various reasons beyond their control, fail to establish rules of cooperation with a POZ doctor, have to give up their own activity in the independent contracting of services with the NFZ? What about billing and financing of these services? There are far more questions than answers. If new solutions and changes to the regulations are not worked out, the effective date of the new solutions must be postponed," said the NRPIP president.

The Supreme Council of Nurses and Midwives points to the need to develop such rules that will guarantee the implementation of health services by nurses and midwives to patients not only in offices, but also in the home environment. - One nurse or midwife employed by a medical entity is not able to provide on-site services at the same time in the office, such as those related to vaccinations, and at the same time provide health services to patients in the home environment, such as those with chronic or complicated wounds. Today, there are no guarantees that entities looking for savings will want to hire, let alone establish cooperation with nurses and midwives. - Mariola Lodzinska sums up the situation. The problem is growing with each passing day and brings us closer to 1.01.2025.Its solution is today one of the priorities of the Supreme Council of Nurses and Midwives in the actions taken with the Ministry of Health.

Source: NIPIP