[The economic and labor impact of no staff replacement in primary care. Why and how we should measure it].

Objectives: To quantify the effect of not replacing staff in both job (mean overloads in time -MOT- and in users -MOU-) and economic terms. To calculate the effective real time worked (ERTW).

Design: Cross-sectional descriptive study.

Setting: Primary care, San Fernando Health Centre, Móstoles, Madrid.

Participants: The 41 people in the team.

Measurements And Main Results: Records of time off in 1999, with economic and labour costs. Comparison of the mean patients per shift -MOU- with the gold standard: Royal Decree 1575/1993. 72.63% (14,227,538 pesetas) of the cost of time off (19,589,226 pesetas) was assumed by the team (negative cost, economic impact). The MOT per health professional was 6.6 weeks per year for doctors, 6.5 for nurses and 4.2 for paediatricians. The ERTW per professional was 44.1 weeks a year for paediatricians, 39.4 for doctors and 39.1 for nurses. The MOU on a professional being absent raises the lists to 2471 (medicine) and 2179 (paediatrics) on the morning shift; and to 2296 (medicine) and 1662 (paediatrics) on the afternoon one.

Conclusions: The team assumes most of the economic burden, with no counter-benefit. The MOT is high and exceeds the number of weeks per year of formally allowed time off. In practice, therefore, each professional covers for their full allowed time off. The ERTW is much below the 52 weeks on which the team was assessed. RD 1575/1993 is frequently broken by current MOU. It is suggested that coordinators use these indicators in negotiating the Contract of Care Management and the Portfolio of Services.