Italian Reform of Primary Health Care in a multi-level Governance. The National Recovery and Resilience Plan becomes the last opportunity to promote a much needed new organizational model.

Public healthcare was born in Italy underfinanced, allowing doctors to supplement their earnings with freelance work. With the development of the mutual system, the general practitioner remained a freelancer while hospital doctors were allowed to practice freelance. National Health System born in 1978 inherited this professional duality. Therefore the gatekepeer of the access and daily care of users is a private doctor with a loose agreement. The new health district was born with great hopes and a weak institutionalization. That's why it did not see its equipment and management capabilities grow in step with the hospitals which, on the contrary, were increasingly under the attention of public opinion and politicians. Yet doctors, experts and politicians agree on the fact that in the face of the inexorable aging of the population and therapeutic progress, the growing demand for treatment can only be supported with a strong capacity for prevention, medicines initiative, home care and therapeutic continuity outside the hospital. As more and more vulnerable people live alone a social integration of the health care will be necessary. Health plans and national reforms have not been sufficient to effectively strengthen primary care. Investments in reception facilities have finally arrived with the NRRP. With Decree 77, the Draghi Government has adopted as a model the organizational experiences of a few regions that had tried to build containers in which general practitioners are called upon to work together with public medical and especially nursing staff. To convince all the regions to make this collaboration model work, the NRRP has concentrated its capital account economic incentives on the new Community Houses and outpatient care. Through investments in building containers they want to spread a new model of prevention, continuity of care, home care and local social care. Faced with the serious lack of human and organizational resources, however, there is a high risk that the regions that did not believe in this assistance model until yesterday will now limit themselves to a formal compliance, the minimum necessary to avoid losing the funds made available to them.