Around 40% of Family Health Units (USF) say they have a lack of professionals on the team and more than 80% recorded prolonged absences, which had to be covered mostly by professionals from the same team.
The study “The Current Moment of the Reform of Primary Health Care in Portugal 2024/2025”, developed by the National Association of Family Health Units (USF-AN) and released this Friday, October 17, shows that around 60% of health center coordinators consider that they have a complete team (nurses, clinical secretaries and doctors), with the shortages being more evident in areas with lower population density.
The document states that 81% of the USF recorded prolonged absences and, in the majority of cases (58.2%), the replacement was ensured solely by team professionals.
In 9.2%, replacement was achieved with professionals from outside the team, and in a third of the units (32.6%) it was necessary to mix the two resources.
In most cases, it was necessary to replace doctors, with cases of replacement of other professionals being practically zero.
The data shows that the situation has been “improving slightly” since 2020/21, but, on average, there is still a shortage of one professional from each professional group in the USF, in relation to what was agreed.
This lack is most pronounced among doctors, followed by nurses and then clinical secretaries.
“Right now, we have lists [de utentes] very large and lists of users, that is, they are people who use the service a lot”said André Biscaia.
In addition to consultations, professionals have a lot of non-face-to-face activities, such as responding to emails, answering phone calls, writing reports and writing chronic prescriptions, insisting: “Non-face-to-face activity is sometimes twice as much as face-to-face activity.”
The size of the user list is another priority highlighted in the study, which states that the high number of users per doctor “is one of the biggest obstacles” to the provision of quality care, contributing to the ‘burnout’ of professionals.
Many units consider that the current size of the user lists – resulting from the law that governs the USF – and “the constant pressure from the guardianship and Local Health Units” to increase the lists contribute to exhaustion and loss of quality of care provided, reducing motivation and the number of professionals who want to work in the National Health Service.
As for careers, more than 90% of USF agree with the creation of a career as a senior clinical secretariat technician and the study highlights difficulties in opening competitions for recruiting specialist nurses and certifying skills within the scope of family health nursing.
In view of the diagnosis, the authors suggest formal compensation mechanisms for prolonged absences and overtime work (in 55.7% of USF, work carried out beyond official working hours is not considered for future compensation).
In the improvement map prepared in this study, USF-AN also proposes the creation of a pool of ULS providers (which integrates hospitals and health centers).
As an example, he recalls that some ULS (especially in the North and Center) have already opened competitions to fill a pool of family doctors to cover these prolonged absences and says that the same should be done for other health professions.
The study is based on responses from coordinators of 538 Family Health Units (USF), corresponding to 77.6% of USFs existing at the beginning of the study. Data were collected between July and September 2025.
At the top of the priorities identified by the coordinators are the need to reconcile activities at the USF and personal/family life and policies that give priority to primary health care, as well as interoperability between IT programs at the USF.
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