PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

83 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceItaly has attempted to address imbalances through Ministerial Decree 77, which establishes new territorial care models positioning general practitioners at the centre of regional health systems. The decree provides infrastructure and support to make primary care practice more sustainable and attractive, including team-based models, administrative support, and modern facilities. However, implementation is still in the early stages, and faces challenges with respect to regional uptake, digital integration and workforce availability. Demographic pressures and career attractiveness The healthcare workforce faces an unprecedented demographic crisis as ageing professionals approach retirement without adequate replacement pipelines. This crisis coincides with dramatically increasing demand from ageing populations with complex multimorbidity. The ageing workforce Poland’s situation illustrates the urgency: physicians average 50.8 years and nurses 50 years, with substantial proportions already exceeding normal retirement age but continuing to work due to replacement shortages (Health Needs Maps, 2025). Rural areas face particular challenges as older physicians retire without successors, leaving communities without medical care. The ageing workforce also struggles to adopt new technologies and care models, potentially limiting innovation in NCD management. Canada exemplifies this demographic challenge with nearly 18% of healthcare workers aged 55+ in 2024 compared to 9.5% in 1998 (Statistics Canada, 2025). Rural areas face accelerating workforce decline with nurse practitioners dropping from 18% to 14% of the rural workforce between 2013- 2022, alongside declines in nursing more broadly (CIHI, 2023; PHAC, 2021). The loss of experienced practitioners particularly affects chronic disease management, where long-term relationships and deep community knowledge enhance care quality. Whilst experience benefits complex case management, physical demands of practice and resistance to new approaches may limit effectiveness. The concentration of older physicians in solo practices also impedes team-based care models essential for comprehensive NCD management. Declining career attractiveness The declining attractiveness of primary care and prevention specialties among medical graduates compounds demographic pressures. In Germany, younger doctors increasingly favour part-time work and better-paid, technology-oriented specialties such as radiology and ophthalmology, which benefit from high reimbursement for outpatient surgical procedures (Johna, 2024; Sachverständigenrat, 2024; Wangler & Jansky, 2024). Greece sees only 6% of medical graduates choosing general medicine compared to the EU average of 26% (Ministry of Health Greece, 2023e, 2024d), a proportion that continues declining despite desperate need. This reflects multiple factors: income differentials favouring specialists, with specialists earning 2-3 times primary care incomes; limited career development opportunities in primary care; high administrative burden in general practice consuming up to 40% of working time; and lower prestige associated with prevention compared to acute care specialties. Spain has implemented substantial annual salary increases for family medicine residents to improve the specialty’s attractiveness, yet struggles to fill primary care positions (Bernal-Delgado et al., 2024). Medical students sometimes perceive primary care as providing fewer opportunities for professional fulfilment and the use of advanced clinical skills compared to other specialties. The overwhelming workload and time pressure in primary care deter graduates who observe burned-out mentors struggling with unsustainable patient loads.