Yesterday morning, 15 September 2026, GPs affiliated with SMI — the Italian Medical Union — went on strike across Italy.[1] Demonstrations took place in Rome, Milan, Palermo, Naples and Pescara. Today, 16 September, the strike continues. At the centre of the protest: the Community Health Centre agreement signed on 23 June, which imposes 6 mandatory weekly hours in territorial facilities on contracted GPs. But the most significant fracture is not between physicians and the Ministry — it is between physicians themselves.
SMI — Strike demands
No to mandatory time obligation
The 6 weekly hours in Community Health Centres must be voluntary, not mandatory. GPs cannot be forced to work in facilities that in many cases are not yet operational.
No to the single role in general medicine
SMI calls for a dual channel: those who want can opt for public employment, but the liberal-professional convention must remain available.
University specialisation school
Activate a real university specialisation in general medicine, equivalent to other specialties, to increase professional attractiveness.
Adequate protections
Recognition of accident, maternity and pension protections equivalent to those of public employees.
FIMMG — Why it is not joining
Signed the 23 June agreement
FIMMG — the most representative union with over 40% of GPs — participated in the negotiation and signed the agreement. It does not consider a strike the right instrument at this stage.
Prefers negotiation to strike action
FIMMG's position is that general medicine problems are resolved at the ACN 2025-2027 negotiating table, not with a strike that penalises patients already facing waiting list difficulties.
SMI vs FIMMG: two different positions on the Community Health Centre reform — September 2026
The SMI-FIMMG fracture: what it really means
The fact that FIMMG — the majority union with over 40% of GPs — signed the agreement and is not joining the strike is politically significant. It means the representative majority of the profession chose negotiation. But it also means that a significant portion of GPs do not feel represented by the agreement signed on their behalf. In a context of structural shortage — with 5,700 missing GPs and fewer applications than training places[3] — this fracture is not a detail: it is a signal of the difficulty in finding an agreement that combines sustainable working conditions with territorial model reform.
The agreement's weakest point — and why SMI contests it most forcefully — is the asymmetry between obligation and reality. The agreement requires 6 weekly hours in Community Health Centres. But fewer than 4% of PNRR-planned Community Health Centres are fully operational.[3] A physician obliged to work in a facility that does not exist or does not function is in a paradoxical position — with the obligation but without the context.
Beyond the strike, Italian GPs' demands say something simple: general medicine in Italy is in crisis not for lack of resources — EUR 300 million has been allocated — but for lack of sustainable working conditions. Bureaucratic burden, isolation, inadequate pay, absence of protections. These problems are not solved by an agreement on where the physician must spend 6 hours per week. They are solved by changing structural working conditions.
See also our articles on Community Health Centres, on the GP crisis in Italy and on Italian physician burnout.
What does the 23 June 2026 Community Health Centre agreement actually provide?
The 23 June 2026 agreement — signed by FIMMG but not SMI — establishes that contracted GPs must provide at least 6 weekly hours in Community Health Centres, in addition to activity in their own practice. Additional remuneration is provided beyond the per-patient fee, funded by approximately EUR 300 million allocated for 2026. The agreement also introduces the principle of a single role in general medicine, which SMI contests because it reduces the distinction between primary care and continuity of care physicians.
Why do FIMMG and SMI have different positions on the reform?
FIMMG is the majority GP union — with over 40% of members — and actively participated in negotiating the 23 June agreement. While acknowledging structural problems in general medicine, FIMMG believes changes should be pursued at the ACN 2025-2027 negotiating table, not through a strike that penalises patients. SMI, a minority but active union, considered that the agreement imposes excessive obligations without necessary protections, and that a strike was the only instrument to bring the Ministry back to the table on specific points.
What is guaranteed during the GP strike?
During the SMI strike of 15-16 September 2026, urgent services are guaranteed: urgent home visits, integrated home care, scheduled home care for terminal patients, and services considered essential by regional agreements. The strike concerns SMI members only — FIMMG did not join, so many practices remained open. Disruption could occur in routine ambulatory activity, scheduled check-up visits and continuity of care services.
Will Community Health Centres actually work with this agreement?
That is the central question. The agreement resolves the GP obligation issue — but not the infrastructure one. Currently, fewer than 4% of PNRR-planned Community Health Centres are fully operational. A GP obliged to 6 weekly hours in a facility not yet functioning is in a paradoxical position. The reform's success depends on the speed of facility activation — which in turn depends on nursing staff availability, information systems and regional resources. The agreement alone is not enough.
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