Excessive workload stifles primary care

Entry type: Single project

Country/area: Spain

Publishing organisation: Civio

Organisation size: Small

Publication date: 2022-11-24

Language: Spanish



We are the first organisation in Spain to specialise in monitoring public authorities. We demand transparent governments and institutions, and informed citizens. And we do this through journalism, advocacy and technology. In this investigation have worked Ángela Bernardo, science journalist; María Álvarez del Vayo, data journalist; Carmen Torrecillas, who works in web development & data visualization; and David Cabo, codirector of Civio and developer.

Project description:

The healthcare system in Spain is in the middle of a turmoil. Primary care professionals are taking the streets demanding better conditions. In this investigation, we release, for the first time, the data that reflects the issue: the **care pressure is extremely high in some regions, rising to more than 40 patients per day for some physicians and pediatricians**. Nevertheless, experts declare the problem is worse than the official data shows.

Impact reached:

The workload of healthcare personnel in Spain has reached unprecedented levels, even when the worst of the COVID-19 pandemic seemed to be behind us. Many primary care professionals are taking the streets demanding better conditions at work, in a situation where patients wait even weeks for a doctor appointment. With this investigation, we quantify the overwork with unpublished data up until now: the care pressure -number of patients seen per healthcare professional per day- is around the record figure of 40 patients in the case of family doctors and pediatricians in some health areas in the country. This means that a doctor can spend less than 8 minutes caring for each person. However, specialists warn that the reality is much worse than the numbers reflect.

It doesn’t look like this situation will be temporary. The data shows that the deterioration of primary care comes even before the pandemic. For this reason, we have created a search engine so the reader can find out two key data on primary care saturation in their own health area from 2018 to late 2022. These are: 1) the care pressure, and 2) the assigned quota of patients. We intend to keep this map alive and updated by requesting new data to public administrations every year.

All our work is open for republication and the database is available for anyone who wants to check it or use it for research purposes. It has been downloaded more than 40 times by researchers, organizations and journalists. Thanks to this way of doing journalism, at least nine regional media outlets have created their own stories with the data on care pressure: Cadena Ser, La Verdad de Murcia, El Diario de Córdoba or Atlántico Hoy, among others.

Techniques/technologies used:

Getting the data this investigation is based on was the first and probably most difficult step taken. We did several FOIA requests since the data was not published. Actually, we are still fighting with public administrations to release the care pressure data of some health areas, even after the publication. Once we had most of the data from 2018 to 2022, we started working on homogenization and analysis of the database with Excel.

Then, we decided to create a map-search engine with all the health areas data. To do so, we contacted the open data portals of each region. All of them had this information geolocated and downloadable except the Community of Madrid. Our numerous attempts to obtain their 7 health areas of that region were unsuccessful, no one has been able to provide us with such geographic information to date. Then, we had to use the Mapshaper and to elaborate the map in Observable with Mapbox GL JS and d3.js.

Context about the project:

This investigation is a data-driven one, but data, in this case, was not of public domain. However, it didn’t stop us from doing seventeen FOIA requests for each one of Spain’s regions and two more for the autonomous cities of Ceuta and Melilla. This was a procedure that took us five months to complete -in part. Several administrations denied our right to access to the information and we had to reclaim it. Others gave us the data in a different format, time gap and/or desegregation level.

Once we have the database in a reusable format -with some of the information still lacking- we decided to create a map in which the reader could search for its own healthcare region and look at the data of the mean of patients seeing each day for each type of professional and the quota of patients each professional had. This meant that we encountered a new difficulty: we had to contact all the 19 administrations once again for the healthcare regions shapefiles. All of them had it and sent it to us, except for the one with more population: Community of Madrid. Then, we had to use the Mapshaper tool to copy the healthcare regions of Madrid by ourselves.

We plan to keep this investigation ‘alive’ by updating the information every year. Up to this day, we have already made all the nineteen FOIA requests once again for the data regarding the second trimester of 2022.

What can other journalists learn from this project?

That data doesn’t tell everything. Giving voice to experts and healthcare professionals has been key to understand the real issue as well as to fill the gap on certain matters. For example, we couldn’t realize that the mean number of patients seen per day wasn’t taking into account holidays enjoyed by healthcare professionals. Then, the quota of patients would be higher per professional because they will have to assist patients assigned to their colleges on holidays. We also realized that the kind of patients health professionals have in their quota can affect the so called care pressure (mean of the number of patients seen per day): it would take longer to assist elderly people or people with comorbidities than young healthy people. Listening to people who suffer this situation both as a patient and as a professional has been the most important part of the data analysis in this case.

Also, something that Civio has learnt during all the years of investigation is that the reader often wants to interact with the data. That is why many of our investigations have interactive visualizations that locate the IP of the reader and offer a personalized experience. In this investigation, we have kept that in mind, developing a map where the reader can search for its own healthcare region and look at the care pressure where he or she actually goes to the physician.

The methodology and database of this investigation is open and free to be checked by anyone interested in it, specially local journalists. This allows new approaches to be developed with the same exact data. We believe that transparency in the process and limitations allows readers to trust the final work.

Project links: