More than 3 thousand employees will be added to SNS, but the rate of family physicians will not change

In the 2026-2028 plan announced for Portugal's National Health Service, the number of employees is expected to exceed 160 thousand, health expenditures will increase by more than 1.2 billion euros and more surgeries will be performed. On the other hand, the rate of users assigned to a family doctor will remain at 85.37% for three years. In other words, the current plan does not foresee a percentage expansion of family doctor coverage until 2028.

The Portuguese government's new Quadro Global de Referência (QGR) document for the Serviço Nacional de Saúde (SNS), covering the period 2026–2028, has revealed important targets for the next three years of the healthcare system.

The document, approved by Finance Minister Joaquim Miranda Sarmento and Health Minister Ana Paula Martins, was published in Diário da República on September 4.

Although the decision has been published, it is valid as of January 1, 2026.

Plan; It foresees changes in many areas, from the number of personnel to health expenditures, from surgeries to emergency room applications.

However, a remarkable picture emerges regarding family medicine.

Family doctor coverage 85.37% for three years

Percentage of SNS users assigned to a family doctor according to the official plan:

2026: 85.37%

2027: 85.37%

2028: 85.37%

It is predicted as.

Moreover, the same rate was at 85.37% in 2024.

While 85.32% is seen in the table for 2025, it is planned to increase again to 85.37% in 2026 and then remain at the same level until the end of 2028.

For this reason, official targets do not foresee a percentage expansion of family doctor coverage over the next three years.

Conversely, the targeted rate of 85.37% means that approximately 14.63% of the users will not be included in the scope of users assigned to family physicians.

However, it is not correct to directly convert this ratio to a certain number of people. Since the total number of users registered on SNS may change over time, the exact number of people without a family doctor in 2028 cannot be calculated today.

In return, the number of SNS employees will increase

In response to the stable target in the rate of family physicians, an increase in the total number of personnel of the health system is planned.

According to the official QGR table, the number of SNS employees is:

From 157,080 in 2026

to 160,242 in 2028

is expected to come out.

This means a net increase of 3,162 people over the three-year plan.

The document also includes provisions for SNS organizations to recruit the necessary professionals.

In 2026, an increase in headcount of up to 1.4% is allowed compared to the headcount on December 31, 2025. Indefinite-term employment contracts can also be used for new hires.

More doctor's examinations and surgeries are targeted

The government aims to increase SNS's healthcare production in the same period.

Number of doctor's visits in SNS according to the official schedule:

From 47,783,832 in 2026

to 48,744,287 in 2028

will rise.

The number of surgeries is:

from 799,499 to 831,799

is expected to come out.

This means approximately 32,300 additional surgeries between 2026 and 2028.

The target of fewer visits to emergency services

Another notable target of the plan is emergency services.

SNS, emergency service applications:

From 4,593,426 in 2026

to 4,277,513 in 2028

predicts it will fall.

If this target is achieved, approximately 316 thousand fewer applications will be recorded in emergency departments within three years.

However, the document does not present this figure as reducing access to healthcare, but as part of the SNS's goals of improving overall access, efficiency and integration of healthcare.

Health expenditures will increase to 19.7 billion euros

SNS's total expenses are also expected to rise significantly.

Total expenditure according to the official plan:

From 18.498 billion euros in 2026

to 19.714 billion euros in 2028

will come out.

The difference is approximately 1.216 billion euros.

In return, the aim is to reduce SNS's debt.

Planned debt amount:

2026: 891 million euros

2027: 807 million euros

2028: 785 million euros

SNS aims to increase healthcare production and number of employees, on the one hand, and reduce the debt level, on the other hand.

The debate on nurse employment continues

The publication of the plan coincided with a period when discussions about the employment of healthcare workers were continuing in Portugal.

Organizations representing nurses point out that while staff shortages continue in the healthcare system, there are thousands of new nurses ready to enter the profession.

Sindicato dos Enfermeiros Portugueses (SEP), on the other hand, criticized the personnel increase limit in the new framework.

The union argues that the regulation to increase the number of employees by a maximum of 1.4% in 2026 compared to the December 31, 2025 level may make it difficult to recruit new personnel at the required scale.

This assessment reflects the opinion of the union, not the government.

Why is QGR important?

Quadro Global de Referência is not just a document of political intent that explains the general goals of the SNS.

It forms the strategic and financial framework used in the three-year planning of healthcare organizations in Portugal.

Local health departments and other relevant organizations within the SNS use this framework as a basis when preparing their Planos de Desenvolvimento Organizacional (PDO) plans.

Document; It is one of the basic planning tools that determine the direction of SNS in the coming years in areas such as personnel, budget, investment, production of health services, access, quality and efficiency.

Therefore, keeping the rate of family physicians constant at 85.37% until 2028 is not only a determination of the current situation; It is noteworthy that the government has not set a higher target for this indicator in its current three-year plan.

PRACTICAL KNOWLEDGE

The official plan's family doctor indicator measures “utentes com médico de família atribuído”, that is, the proportion of SNS users with an assigned family doctor.

2026–2028 target: 85.37%

This figure should not be read as meaning that a precise 14.63% of the Portuguese population will not have a family doctor in 2028. The indicator is calculated based on registered users on SNS and the total number of users may vary.

The entire document can be viewed free of charge on the Portuguese Official Gazette, Diário da República.

REVIEWED SOURCES

Diário da República — Despacho n.º 10981-A/2026, 4 September 2026 — The official and primary source of SNS's 2026–2028 Quadro Global de Referência; access, personnel, activity and financial indicators were checked here.

RTP / Lusa — 4 September 2026 — “Quadro de referência do SNS prevê estagnação da cobertura de médicos de família até 2028”; Key indicators of the plan and current discussions regarding healthcare professionals.

Sindicato dos Enfermeiros Portugueses (SEP) — ​​September 4, 2026 — Union evaluation and criticisms regarding QGR's personnel policies