The new manager of Primary Care for the Pamplona area, Yolanda Martínez, considers that the future of this level of care lies in “being decisive and accessible”
“I wanted to do Medicine, but I didn’t have financial possibilities. When I finished Nursing, with what I earned working I paid for my Medicine degree, but as a nurse I was very comfortable. What’s more, all the professionals who have worked with me know that I do so much one thing like another and I am comfortable in both jobs”, explains Yolanda Martínez Cámara, new manager of Primary Care in the Pamplona Area. This physician, born in Hernani (Gipuzkoa) and 49 years old, faces the challenge of implementing the Primary Care Action Plan. She reiterates the importance of the teams to “meet the needs of the population, that we are not only talking about treating pathologies”, since “the most important thing is the promotion of health, the prevention of diseases”.
Congratulations. Assumes the management of Primary Care when this care level is in its most critical situation. Why did you decide to take the step and accept this position?
–Well, they offer it to me explaining that they needed someone to implement the Primary Care challenge. It seems to me a very good project, very optimistic, I am encouraged and decide to accept to try to start it. It didn’t cost me much; They convinced me anyway, I don’t know -smiles-.
What convinced you of the project?
–Above all the excitement and optimism that the project has. Given how bad we’ve been and how bad we’ve had it in the last two years in Primary due to the volume of work, due to the lack of professionals… it seems to me that it is a challenge that can be very good for the Primary Care.
Some say that he is dying, that he is in the ICU€ What is the current situation of the Primary in Navarra?
-I don’t think that Primary Care is dead, nor that it is in the ICU. I believe that we have had problems, which have been serious, but that we continue to have a very strong Primary and great professionals within it. What difficulties do we have? Yeah, but I don’t think she’s dead at all.
What are those serious problems?
-The most serious problem we have is the lack of professionals, which has accompanied us and will continue to accompany us for several years. And then we have other types of problems, which are also important, especially in terms of accessibility, problems of space, infrastructure…
What goals do you set?
–In principle, the most important objective, the one that we prioritize the most, is accessibility, to return to having the accessibility that we had before. To be the Primary that we all had before in Navarra: accessible, that the population can access their family doctor whenever they need it.
What percentage of consultations are attended in person now?
I don’t have the complete data for this month. In the sixth wave, a large population was served by telephone and, of course, the percentage of non-attendance rose, but not at the expense of the drop in attendance. Now, in the last month attendance has increased by 10%.
We have been hearing about the Primary Care Action Plan for months. The professionals ask that they now move from declarations to facts. When are you going to start implementing measures?
-Next week we have a meeting of all the Navarra team managers on the 11th. It is going to be a day of work, pooling and kick-off, within which many things were already being worked on, but from that day on, work will begin in common center by center to implement all the changes and the challenges.
What are those changes?
–In principle, the organizational model will be changed in a certain way, starting with Nursing, and then there will be more hiring. Specifically, six Social Work professionals and throughout the year 104 nurses will be hired, who will be given a work plan. They will not be substitutes. The project is not that; The project is that the nurses have some objectives and a specific work plan and we are going to work on that plan after March 11 center by center. In addition to attending to the usual work, both in cures, in prevention processes, in health promotion, in health education, they are going to attend to low-complexity processes: digestive, urinary, and respiratory. .. That has its protocol and its age range between 7 and 69 years. Of course, patients with chronic diseases and older or younger patients will always be cared for by a doctor and, I insist, that it is teamwork.
How is this organizational change going to affect Nursing, Medicine and Admission specifically?
-From Admission is already working. We have changed the switchboard in most centers, we have installed an intelligent switchboard in the Pamplona centers so that telephone calls can be optimized and more will be implemented according to needs. And then educators will be hired for the largest health centers, to support the Admission service. Of course, the training of the staff is planned so that the citations are optimized and adapted. In addition, the services of the Personal Folder will be optimized, enabling the web appointment request for face-to-face consultations. On the other hand, from Nursing, which was already something that was being done, they will attend to acute processes. They were seeing patients with low-complexity pathologies and it is thought that they will attend to more patients. It’s about teamwork, I don’t think we’re going to put in nurses either because there are no doctors, that’s what a lot of people say and that’s not the idea,” he emphasizes. I always say that the work in a health center is not the doctor’s or the nurse’s; It is a team job and the distribution of tasks will be optimized.
The pandemic has highlighted the importance of having a strong Primary Care, but also that the current system has become obsolete. What are the challenges ahead?
-Primary Care must stop being something static to change with society and not only with the pandemic. Yes, it is true that with the pandemic we have had to modify many things and, in addition, we have had to adapt very quickly, but that is the biggest problem that I see that we have had in recent years, not adapting to changes of the society.
In fact, professionals complain that the organization of care in health centers has not changed since it was established 37 years ago, and yet the health needs of citizens have evolved. What needs to be done to improve current patient care?
–The first thing is to improve accessibility. We have been implementing many things to improve, for example, teledermatology. Now we are taking photos, we send them to specialists in Dermatology, ultrasounds, there are many things that have been improved digitally and that is one of the first objectives and one of the first lines of work that we have. Many more services will be implemented in the personal folder, it will be possible to access sick leave through it and we will be able to send them to our company… Many things that will improve and will adapt our work a little to the world we live in. Now all the professionals have all the equipment, they have a smartphone, they can communicate, they can make videoconferences, both with specialized professionals and with the population… We are in this line of work.
Professionals have been denouncing an extreme work overload that reached its peak in the sixth wave. How do you plan to alleviate this high care burden and resume the activities that have been stopped due to covid?
–Many of the activities have already been resumed, for example the plan for chronic multi-pathological patients, humanization… and more will be resumed until we manage to return to normal operation. Of course, the overload of professionals is high, in the waves it is high, it is undeniable, there have been professionals who have been out of action, unfortunately we do not have professionals and it is a problem that we are going to have for a long time. We are working on things that we are not going to see a short-term solution. For example, for two years instead of 28 residents, 40 are being trained, but those 40 will not end in two years. This year they finish 28. Our goal is to offer them great contracts and that they want to stay and work with us. On the other hand, there are the two OPEs, both that of Paediatrics and that of doctors from the Primary Care emergency service and the rural emergency service. The one for paediatricians is already finished, there are 34 professionals who will be appointed this week and we anticipate that they will join in May. And, then, in the general OPE there are 107 places, which the idea is that they will also be incorporated in May. So, I think that many places that until now we had not covered, which are difficult to cover, are going to be covered thanks to the OPE. In addition, there are several doctors who took jobs in other communities and who are going to return to Navarra; yesterday I spoke with four who return. It is not a solution, but it will be a respite. In addition to the 28 residents who finish this year and who have a job offer on the table.
He has a great challenge ahead and little time. What goals or achievements would she be satisfied with?
But I don’t think I’m going to finish it this year. Let’s get started on it. I will be satisfied if we improve accessibility. I have two objectives: the first is with the patient, I want him to improve the image he has of Primary Care and for us to once again be his reference and his contact; but I don’t want to forget about the professional and I also want that in this management that I have ahead of me we improve, that the professionals are happier.