Table 1 Overview of the Portuguese health system [7,8,9,10,11]

The Portuguese health care system consists of several coexisting and overlapping systems: the universal NHS, health subsystems for certain professions, private health insurance, and the private sector

Coverage in the NHS includes most health services, except for dental care. Care is free in primary care, oncology and mental health services. The remaining services charge low user fees but only to adults with an income above a defined amount

Maximum waiting times for services are set by the government but compliance is uneven across both primary and secondary care

GPs are largely salaried public servants working in approximately 920 group Family Practices owned by the NHS and grouped into 55 Health Centres Groups

In NHS Family Practices, each GP cares for a list of about 1700 patients but over 10% of the population has no assigned GP due to a growing shortage of GPs working for the NHS

Family Practices in the NHS are organized in three models:

 • 32% are Model B clinics, using a mix of salaried, capitation and pay-for-performance schemes

 • 33% are Model A clinics, using a salary-only scheme while organizing their practices to reach model B status

 • 35% are ‘UCSP’ clinics, using a salary-only scheme without the intention of reaching model B and having the additional task of caring for patients without an assigned GP

Telephone contact between GPs and their patients is a common practice but, before the pandemic, less than half of GPs reported using electronic mail with their patients on a regular basis

The NHS patient internet portal, launched in 2013, includes online GP appointment booking, repeat prescription ordering and a personal health record function, where patients can enter their health data