After the holding of general elections, a new opportunity presents itself to review the challenges that lie ahead for our National Health System and how to address them. From the General Council of Physicians and in collaboration with scientific societies and the IMAS Foundation, we recently carried out a complete diagnosis of the public health system and measures to improve it.

I want to start with the structural problems, such as the separation between public health and healthcare, which has led to a predominantly curative rather than preventive approach.. This paradigm must change and for this it is necessary to reorient the system towards health promotion and disease prevention through the implementation of structures that integrate public health and health care.

Another structural aspect is the health education of the population. Undoubtedly, working in this direction will be essential for proper use of health services.. We must raise awareness throughout society about the health system and respect for health professionals, as well as promote the therapeutic alliance between doctors and patients, and the participation of patient associations and scientific-medical entities in the reorientation of public health.

Another challenge that has a direct impact on the structure and approach of the SNS is the increase in the population of elderly people and patients with complex chronic diseases, as well as unwanted loneliness.. To solve this immense challenge, we must develop comprehensive care that incorporates the necessary social and professional resources to provide quality care, including multidisciplinary teams, prevention of frailty, and palliative care..

In this sense, we cannot forget that greater integration between primary and specialized care, as well as the creation of care networks that guarantee continuity of care, represent a giant step forward in this regard.. But we must also face in the coming years the expansion of the portfolio of services of the public health system, especially in mental health and oral health, to close the existing gaps compared to other developed countries.

The crisis generated by the pandemic has highlighted the need for an effective governance structure in the health system that provides it with transparent, participatory governance based on scientific evidence.. In this sense, steps have been taken such as the creation of the State Public Health Agency, but it still needs to be put into operation to, among other actions, order and assess the results of the health system and establish a shared information system.

And if we talk about major changes, we cannot ignore the patients. It is essential to incorporate patients in the government structures and in the decision-making process of the health system, guaranteeing their active participation and promoting shared decision-making.. But if patients are 50% of the SNS, the other 50% is made up of health professionals, authentic bastions of the SNS. Therefore, involving the medical profession in the planning and management of the health system and improving the doctor's experience in the National Health System through their participation in the management of the system, promoting their autonomy and responsibility is, simply, a large part of the solution.. But this implication will not be total without improvements in the working and motivational conditions of doctors that allow increasing the quality and efficiency of the system.

The organization and management of health systems are another key to take into account. This will make it possible to establish quality standards, make the results public and encourage the participation of scientific-professional entities in health policy.

All these changes and movements must go in rhythm because the transformation of our system cannot be done in sections and patches or it will fail.. It is necessary to have a holistic vision, and this implies developing assistance models adapted to the needs of citizens. Along these lines, it would be positive to organize care based on groups of patients with similar needs, develop multidisciplinary teams, measure results and costs by subgroup of patients, and strengthen community care.

If we talk about transformation in the year 2023, we cannot ignore the “digital” concept. Promoting a digital transformation of the SNS that includes, among many other aspects, the use of technologies such as artificial intelligence and the citizen's digital health history, is absolutely basic.. To do this, it is necessary to establish a digital health strategy, promote the automation of processes and foster the digital education of professionals and citizens.

In short, these are the ten great challenges that the medical profession consider crucial when it comes to rebuilding a health system that is in danger. A system that allows sustaining the universal, public and free healthcare model that for more than 40 years has helped build and unite our country. A State pact for health is urgently needed to consolidate and strengthen this pillar of our welfare state, a consensus that perhaps now has a new opportunity to start its journey.

Tomás Cobo Castro is president of the General Council of Physicians of Spain