"We believe that the generalization of the ULS model, being applied across the country and in the way it is being carried out (...) does not serve the users, the professionals and the management. Therefore, we believe it is appropriate to point out that we do not agree with something that we consider a real setback for Primary Health Care", they say in a letter addressed to the Minister of Health, Ana Paula Martins.

At issue is the merger, in ULS, of primary health care (CSP) and hospital centers, a measure carried out by the previous Executive Directorate of the National Health Service (DE-SNS) led by Fernando Araújo.

The coordinators of the health centers of Gondomar thus join the coordinators of the health centers of Western Porto, also integrated in the ULS of Santo António, who sent an identical letter to the supervisory authority in May.

In total, there are about 50 signatories to the letter who express "concerns" about the new model and propose alternatives, speaking of "verticalized management with an effective loss of autonomy of the CSPs".

They also state that the new management model that "centralized services and resources in the ULS increased bureaucracy and reduced decision-making capacity in the CSPs, impairing their rapid and adequate response to local needs".

The signatories criticize "the creation of gigantic institutions" that entails a "risk of depersonalization and dehumanization of health care", to which is added the "risk of inadequate allocation of resources" due to "ignorance of local realities".

"There is no shared care integration plan and no initiatives are known in this regard. Care integration cannot be carried out by decree, especially when there is a perception among professionals that the change does not bring added value, on the contrary", they add.

In the letter, these professionals also express concern about the "secondary role of CSPs in relation to secondary hospital care" and call for the "adoption of an ACeS model with autonomy (...) in which there is sharing of resources at regional level that would enable economies of scale".

"[This] would represent a significant step towards a more adaptive, autonomous organizational model focused on local needs and citizens", they conclude.

The new organizational model of the SNS came into force on January 1.

The restructuring, which in practice translates into the integration of health centers and hospitals into a single structure, excluding specialized ones such as oncology centers, was dictated by Decree-Law 102/2023, of November 7.

The ULS of Santo António brings together the Santo António University Hospital Center with the ACeS of Grande Porto II (Gondomar) and Grande Porto V (Western Porto).

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