Spanish primary care and emergency care on the brink of collapse

by Lorraine Williamson
more people go to emergency than doctor

MADRID – The emergence in Spain of the Omicron variant and its high transmissibility has put the population on edge. Many health centres and emergency departments have already reached saturation point. 

This situation of saturation creates a knock-on effect on the rest of the health care system. Furthermore, the new variant of the virus is causing a lot of uncertainty among people. Not only because of its health risks but also because of the approaching Christmas holidays and the planned family gatherings. Therefore, healthcare centres in Spain are flooded with insecure people with questions about health problems and precautions to be taken. El Confidencial newspaper writes this saturation in primary care is visible through the long queues at the health centre doors.  

However, “the breakdown is not because everyone who comes has tested positive. People come with symptoms or questions because their contacts have symptoms,” explains José María Llanos of a health centre in Madrid. “Many people come without an appointment because they are sick, or have had a fever at the weekend. They have questions because they have been in contact with an infected person or have symptoms themselves. Often these are symptoms that can also indicate the flu,” says the nurse. Added to this are the normal activities of appointments for other health problems and giving vaccines. The burden of care for the centres is becoming too great. 

For Vicente Baos, a primary care physician at Collado Villalba-Pueblo Health Centre (Madrid), this collapse is part of a health care system that was already on the brink before the omicron outbreak. Added to this are vaccinations (flu, pneumococci and Covid-19), the bureaucracy surrounding people who have tested positive for Covid and the fear of the new variant of the coronavirus. 

“Everyone wants a consultation” 

“The collapse comes just as respiratory infections increase and everyone fears that it is covid. Normally people with catarrhal symptoms did not go to the doctor in November. However, that is different now! Now everyone wants a consultation,” says the doctor.

Primary care Madrid 

The exponential increase in cases due to Omicron and the fear of this variant is already leading to the collapse of primary care in the Madrid region. Professional organisations warn against this, according to El Confidencial. They also warn of the “serious consequences” that this situation will have on the entire healthcare system in the region. Emergency services are overcrowded, hospitals are at their maximum capacity and the Emergency Service 112 (SUMMA) is saturated. 

Professional colleges sound the alarm 

The College of Physicians of Madrid and the Professional College of Nursing Staff (Codem) are both sounding the alarm: “Primary care is currently collapsing.” “We came from underfunded primary care, especially in terms of the number of nurses serving an aging population, with more chronic pathologies and with greater care needs. There has been no strengthening of this primary care since the pandemic, with there still being a lack of nurses to care for everyone. This is even more so in light of a sixth wave in which it is also necessary to conduct source and contact investigations again. In addition, there is the vaccination campaign for children under 12 years of age and we are in the process of administering the third dose,” said a Codem spokesperson. 

Cogesa Expats

Uncertainties about Christmas dinners 

The problems are not limited to the Madrid region. The professional associations in Aragon have already called for “immediate action in the event of a collapse”. In the Basque Country, the situation is similar after the dismissal of 4,000 healthcare professionals in October. Asturias and other regions are already seeing outpatient appointments postponed. The same goes for Catalonia and Galicia. 

Domino effect: emergency room is starting to get saturated 

The aforementioned collapse of primary care is causing a knock-on effect in the rest of the health system – both due to Covid and other minor pathologies. This is already visible in the emergencies in Madrid hospitals. 

“Nobody takes action” 

Elena Álvarez Cabañas, an emergency nurse at Severo Ochoa Hospital, confirms a “lack of personnel, resources and action strategies.” When patients can no longer go to primary care, they go to the emergency room, which also eventually collapses due to the non-emergency pathologies. “No one is taking action to solve the problems… It is outrageous,” continues Álvarez Cabañas. 

The same is happening at Gómez Ulla Hospital, where the emergency department is very busy with mild-covid pathologies or other problems that are not related to the virus nor are they really urgent and that could have been easily treated or solved by primary care. 

For a corona test to the ‘urgencias’ 

Then there are a lot of people who come because they have no other option to do a quick test. “On Saturday we had 40 people in the waiting room. We normally have 15,” says a doctor from Gómez Ulla. “When health centres collapse, people go to the emergency room. They generally come up with things that aren’t urgent. But because the clinic hasn’t given an appointment for weeks, people go to the emergency room to get it resolved. Even if it’s a five-hour wait,” he adds. 


All professionals in the sector in Madrid agree that there is a need to immediately restructure the primary care centres and hire more staff. In addition, selective priority should be given to all urgent or non-delayed care and the rest should be limited again simply because there is a shortage of staff. 

Early or extended school holidays 

The College of Nurses emphasises the need to hire staff for Covid-19-focused positions in health centres. Likewise, the collective is calling for awareness campaigns about the coronavirus and the restrictive measures and for early or extended school holidays to prevent the spread of the new variant among unvaccinated children. 

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