Acceptability of the Health Service Contract by Primary Care Health Professionals in Madrid: A Qualitative Research

Abstract

Background: The objective of this paper is to study whether the Contrato Programa-based management fomula between INSALUD and Primary Care Managerships (CP) is known by INSALUD-Madrid primary care physicians and nurses, as well as which factors are influencing its acceptability. Methods: Qualitative-based analysis and interpretation of the discussion had in five health personnal groups was used. Results: The Health Service Contrac is known by primary care health personnel as “selfmanagement”. This Word induces them to think in the management of teams by their physicians themselves. Based on this self-management, physicians would plan staffs with minimal representation of nurses personnel, in exchange for increasing medical and administtive personnel, which in fact would solve their main problems, i.e. attendance pressure and bureaucracy, in addition to relationships with nurses. Determinants of this response relate to the satisfaction level with the Primary Care Reform attained by these collectives. This Reform has produced a “subjective equality” in both collectives, conditioned by fault in authority by physicians, which is desired by nurses and rejected by physicians. Conclusions: Health Service Contract in Primary Care is generally accepted by physicians, except for pediatricians, and rejected by nurses. Reasons are related to the ability from both collectives to recuperate the difference between them.