This morning, 12 June 2026, FIMMG — the Italian federation of family physicians — extended an olive branch to Minister Schillaci: "On Community Health Centres we are ready to do our part".[3] The announcement comes the day after the definitive shelving of the decree law that would have brought GPs into public employment. The debate now shifts to the new collective agreement. The PNRR deadline for at least 1,038 operational Community Health Centres is end of June — and today fewer than 4% are functioning.[2]
The problem is not construction. The PNRR has funded buildings, renovations, equipment. The problem is transforming the building into a service. A Community Health Centre without physicians, nurses, functioning information systems and organised access is an empty space — AGENAS counts it as "planned", not "operational". The figures are clear: out of 1,715 planned sites, fewer than 50 are fully functioning according to AGENAS criteria.[2]
6 hours / week
Mandatory presence in Community Health Centres (ACN 2025-2027)
Information systems
Mandatory adoption of tools interoperable with FSE and COTs
Chronic patient management
Structured management of chronic and frail patients in teams
Outcome-based pay
Shift from per-patient to per-objective remuneration
Audits and reviews
Results monitoring, participation in periodic audits
Main changes for GPs in the Schillaci reform draft — collective agreement 2025-2027
The EUR 300 million for 2026
The Ministry of Health has allocated approximately EUR 300 million for 2026 as an incentive for GPs who agree to work in Community Health Centres.[1] This is not a financial obligation — it is an incentive. But the message is clear: those who participate are paid more. The extra remuneration supplements the per-patient fee and covers hours of presence in the territorial facilities.
With 5,700 GPs missing relative to national need and shortages in 18 out of 20 regions,[5] asking existing physicians to dedicate 6 weekly hours to Community Health Centres means redistributing a burden already at its limit. The national average is 1,383 patients per physician — in many southern areas it exceeds 1,500.
If agreement is reached by end of June, the concrete changes for family physicians will be gradual but structural:
The Community Health Centre does not change what the physician does — it changes where they do it and with whom. The risk is that documentary burden increases further, worsening burnout already at 52%. The reform will succeed only if it provides real tools to reduce administrative load, not just new obligations.
See also our articles on FSE 2.0, on automatic SOAP notes and on Italian physician burnout.
Will GPs become NHS employees under the reform?
No, not mandatorily. The decree law providing for mandatory public employment was shelved on 10 June 2026. The path now taken is the new collective agreement (ACN 2025-2027): GPs remain under convention, but with new organisational obligations — including at least 6 weekly hours of presence in Community Health Centres. A voluntary employment pathway is provided for those who want it. The fiduciary relationship with patients remains unchanged.
Why are so few Community Health Centres operational?
The problem is not building construction — many facilities have been completed or converted. The problem is transforming the building into a service. Without dedicated staff, functioning information systems, organised access and services actually available, a Community Health Centre remains an empty space. AGENAS certifies as 'fully operational' only those with continuous medical and nursing presence and services actually delivered — fewer than 4% of the planned total. The bottleneck is always the same: missing professionals.
What does 'outcome-based pay' mean for GPs?
Currently GPs are paid mainly based on number of registered patients (per-patient fee). The reform draft introduces a component linked to health objectives: adherence to guidelines for chronic patients, reduction of inappropriate emergency room visits, active participation in audits. This significantly changes the GP's professional profile — from a consultation physician to a professional embedded in a network with measurable result responsibilities.
How will clinical documentation change in Community Health Centres?
The Schillaci draft makes mandatory the use of information systems interoperable with the FSE and COTs (Territorial Operations Centres). Clinical notes must be structured, digital and shareable with other Community Health Centre professionals in real time. Automatic documentation tools — such as SOAP note and report generation from voice transcription — become particularly relevant in this context, where documentary volume increases further.
Shared team documentation, teleconsultation notes, structured reports for the FSE. Clinovus AI supports GPs in the new Community Health Centre model. GDPR compliant, hosted in Switzerland.
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