Full dedication prevents doctors from exercising leadership roles in the private sector

The regulation of the executive direction of the SNS was published in the Diário da República and will allow “to coordinate the entire assistance response, ensuring its functioning in a network”.

The regulation of the Executive Directorate of the National Health Service, provided for in the SNS Statute, published this Thursday in Diário da República, will go to the Council of Ministers in September, a source from the Ministry of Health assured Lusa.

According to information provided by the Government, the Executive Directorate will “allow for the coordination of all assistance responseensuring its functioning in a network”.

It is also intended that the structure assumes the competences of other entities: management of the system of access to health care, waiting times and the system of subscribers for surgery (Central Administration of the Health System – ACSS), management of the National Network of Continuing Care (RNCCI) and the RNCP — National Palliative Care Network (Regional Health Administrations).

The role of the Executive Board “is different from the Ministry of Health, which is responsible for conducting the national health policy and specific responsibilities related to the SNS, but not the coordination of their responses”, he adds.

It distinguishes itself from the ACSS, “whose mission will focus on the planning and management of financial resources, human resources and the network of facilities and equipment and on contracting the provision of care, from a health system perspective”, he emphasizes.

The Ministry also underlines that the Regional Health Administrations are no longer responsible for care provision and will be in charge of regional resource planning.

The Executive Directorate will also be responsible for “evaluating the performance and response of the SNS, in particular through satisfaction surveys to users and health professionals”.

When enacting the diploma of the SNS Statute, the President of the Republic stated that the document raised doubts in three aspects.

They are “time, the idea of ​​the Executive Management and the combination between centralization in this Directorate and the promises of decentralization of health”.

Regarding the time, Marcelo Rebelo de Sousa said that it remained to be regulated, up to six months, “almost everything essential“.

In particular, he pointed out the legal nature of the SNS and the framework of powers of the future Executive Directorate, which the Government is now committed to taking to the Council of Ministers in September.

Full dedication sets goals for doctors

Physicians who adhere to the regime of full dedication, provided for in the SNS Statute, will have to commit to care goals and are prevented from exercising technical direction, coordination and leadership functions in private institutions.

According to the SNS Statute, the regime of full dedication will be voluntary, it will initially cover only doctors, but it will be extended“gradually and progressively”, to other health professionals.

The full dedication regime is incompatible with the exercise of technical management, coordination and leadership functions in private institutions and in the social sector of health care, but it excludes medical offices of individual professionals.

The Statute also provides that health professionals who, within the scope of the exercise of functions in the SNS, suffer an offense to their physical or psychological integrity are entitled, in the corresponding judicial process, to legal assistance and sponsorship.

Another of the foreseen novelties is that the chairman and members of the boards of directors and the boards of directors, who are doctors, may, on an exceptional basis and “in situations of public interest”, carry out assistance activities in the same health establishment, remunerated and through authorization of the member of the Government responsible for the area of ​​Health.

It also provides that the highest management bodies of the SNS health units designate, at the proposal of the user associations and for a period of three years, a user provider, “which articulates its action with the citizen’s office“.

The user provider is responsible for “representing the interests of users and families, supporting the monitoring of the most vulnerable users during their journey at the health unit and identifying the difficulties and needs of users in the health unit, presenting proposals for continuous improvement of care to the organ. maximum management”.

Autonomy in hospitals and health centers

The new SNS Statute will also allow hospitals and health centers to be given more autonomy, not only in hiring, but also in investment.

The document gives more autonomy to hospitalsfor hiring workers and for investing, as the Finances will only have to approve amounts above 2.5 million euros in projects provided for in the Activity Plans and Budgets submitted to the supervision.

The hospitals’ boards of directors will be able to enter into permanent contracts, whenever the recruitment of workers necessary to fill the jobs provided for in the personnel map and the Activities and Budget Plan is at stake.

In cases where the shortage of professionals may compromise the provision of health care, hospitals’ boards of directors may enter into fixed-term employment contracts for a period of six months, non-renewable, according to the document.

They may also replace temporarily absent professionals, entering into employment contracts with an uncertain resolutive term.

With the SNS statute, the Government also provides clear guidance for the boards of directors to promote new Integrated Responsibility Centers (CRI), which are intermediate management structures with multidisciplinary teams and functional autonomy and which involve the accountability of professionals in the management of resources, “encouraging them to develop their activity exclusively in the SNS”.

These CRI are structures that associate the allocation of incentives institutional and financial measures to the performance actually achieved.

As for the Groupings of Health Centers (ACES), the SNS Statute provides that they are no longer decentralized services of the ARS and become “public institutes of special regime”, with administrative autonomy and their own assets.

The President of the Ordem dos Médicos believes that Marcelo Rebelo de Sousa “did what he had to do” and that the diploma of the new SNS Statute leaves “almost everything that is important to be regulated”.


Miguel Guimarães said this Monday that the SNS statute “gives the idea that the Government has no common thread” to health.

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