The lack of doctors in recent years has been aggravated by their absence. It was published in a media known in Spain that 30% of young doctors who end MIR move to other European countries (United Kingdom, France, Northern countries…). According to the Collegiate Organization of Doctors (WTO), 1,671 certificates of qualifications for working abroad have been issued in the first half of 2019 throughout the country, 20% more than in the same period of the previous year.

With the increase in the influx of young doctors, the autonomous communities have chosen not to compete in search of family doctors, with oppositions for family doctors in all the autonomous communities in the same days. Undoubtedly, the working conditions they offer to these doctors are also in crisis, in a system with low supply and high demand. However, both the political parties and the autonomous communities have decided that job insecurity and wage maintenance will continue.

Chronic patients have also been affected by the excessive turnover of physicians, caused by the precariousness and lack of professionals. The system has already started to provide care through nurses when the waiting time for the physician's attention is long, passing the role of triage to the administrators. It is surprising that an administrative officer asks the patient “what happens to him” or “what is his illness” when he asks for a consultation with his doctor. This question certainly violates the fundamental right of patients to privacy or confidentiality, but in the Basque oasis everything is possible.

Some young doctors who travel to the UK to work can find a similar job situation. And that is that precariousness is something that happens in the United Kingdom, as some scientific journals read. Investment in Public Health in the share of UK GDP stands at 7%. Public investment in the Spanish state is around 6%, after falling almost one point in the last decade. Euskadi allocates 8.7% of GDP to current health spending, but public investment in health accounts for 6.1% of our GDP in equivalence.

Doctors in the United Kingdom demand greater investment in technological infrastructure for public health. Doctors in HD do not apparently ask for anything in this area. In the United Kingdom, virtual consultations with another family doctor have been possible for years through an application by the private company Babylon in a particular area. On Babylon’s system, after you have been discharged from your family doctor, and therefore your family doctor does not charge for your TIS, you can use a triage computer system that will finally provide you a videoconferencing consultation with a different duty physician.

As of July 10 this year, the National Health Service of the United Kingdom (NHS) has contracted the private entity AMAZON, providing virtual health care with telephone assistance to NHS patients, accessing the medical history through robots. Meanwhile, primary care physicians complain that the NHS does not invest in these technological infrastructures in its public network. D. David Oliver, Vice President of the Royal Medical Society, noted that there are great business opportunities, while pharmaceutical and technological companies move around the NHS, which sells their files and data, thus allowing market entities to exploit them and do business.

According to an article written by Paul Webster in the publication Digital Health, this phenomenon is occurring in countries with free public health coverage systems. For example, in Brazil, Canada or the U.S. veterans administration that's paid out of public funds. The incorporation of these digital technologies is facilitating the progressive privatisation of health systems. The IFC agency, dependent on the World Bank, is the promoter of this digital health technology, which finances over 200 projects with 4.3 billion dollars. This technology says it will improve the efficiency of health systems, but the problem the author sees is that these technologies have been developed with a mercantilist view of health care.

In Osakidetza and Osasunbidea, these kinds of virtual consultations are also being promoted, under the name of non-face-to-face consultations, with a simpler technology, such as telephone consultation. Will Osakidetza be able to respond to these technological challenges without increasing public investment aimed at health? Or will you serve private companies such as Babylon or Amazoni in exchange for “exploiting” and using confidential data from Basque patients? In fact, Basque public health doctors are obliged to include this confidential data in the network. Will that be our future? Will they ask Basque patients for permission so that companies and private interests can exploit their data?

And finally, we address the nurses with the reflection: when you receive the call, to attend to the patients who have requested medical consultation, can you tell which of the functions the nursing has to leave without doing to care for the patient? Because we don't think you're going to be in the mids or the burgers until now. It would be unfortunate if patients were left without the usual care of nurses, because some nurses want to play the doctor. Do they consider themselves capable of caring for patients who demand a doctor - with all rights - knowing that they are doctors who have needed ten years of training to get their appointment or contract?

One patient was told that he had to wait two weeks before being able to consult his doctor and that if he accepted the nurse's appointment he had to wait three days; the patient responded that they would allow him to go to a pharmacist who already had knowledge of the effects of the medications. In the end, patients in our country will have to report and care more about public health, because that happy Arcadia, which says that we are the best and that “elsewhere is worse”, begins to embarrass us.

The article was signed by physicians Iñigo Jaca Arrizabalaga and
Xabier Zarandona Zubero.