The Italian government has abruptly shelved its controversial reform of territorial medicine, a flagship initiative by Health Minister Orazio Schillaci that aimed to integrate family doctors into community health centres and place a portion of them on salaried contracts. The decision, communicated by the minister’s chief of staff Marco Mattei to regional health assessors during a technical meeting, marks a significant setback for efforts to overhaul primary care. The decree had already been redrafted after input from the regions but never formally presented, and faced fierce opposition from doctors’ unions and professional orders. From Rome’s perspective, the retreat reflects the government’s reluctance to open a new front with powerful medical lobbies, even as the broader goal of strengthening community-based care remains officially unchanged.

The withdrawal has triggered sharp reactions, particularly from Lombardy’s health assessor Guido Bertolaso, a key proponent of the reform. Bertolaso reportedly stormed out of the meeting and threatened to resign as vice-coordinator of regional assessors, denouncing the affair as “humiliating.” His anger underscores the deep divisions between the central government and regions that had largely backed the reform. Analysts in Milan note that Lombardy, which has long pushed for greater autonomy in health management, sees the collapse as a missed opportunity to modernise a system strained by an ageing population and chronic underfunding. The episode also highlights the fragile consensus within the ruling coalition, where internal disagreements and lobbying by professional groups have repeatedly stalled health legislation.

With the decree withdrawn, the ministry now faces two main options: introduce a standalone legislative measure or embed the reform in the forthcoming renewal of the national contract for family doctors. The latter route, favoured by some officials, would allow changes through an act of guidance rather than a binding law, potentially softening opposition but also diluting impact. Critics, however, argue that this approach risks perpetuating the status quo, leaving territorial medicine fragmented and under-resourced. The opposition has seized on the debacle, accusing the government of sidelining parliament and failing to deliver on a key campaign promise. As the health ministry insists that work “continues,” the practical outcome is a return to square one, with no clear timeline for when—or if—the reform will resurface. For now, Italy’s community health centres remain a vision deferred, caught between political expediency and the urgent need for systemic change.