How a Spanish health-centre visit works, from referral to sick note (baja)

Terms used

• Médico de familia — The médico de familia is your assigned public-system family doctor, who is your first contact and gives referrals.
• Tarjeta sanitaria — The tarjeta sanitaria is the health card from your regional health service that lets you use public care.
• Cita previa — The cita previa is an appointment you must book in advance, by app, phone or at reception.
• Centro de salud — The centro de salud is your local public primary-care clinic.
• Urgencias — Urgencias is the emergency department at a hospital.
• PAC — The PAC is a point of urgent primary care, used for urgent problems outside normal GP hours.
• Parte de baja — The parte de baja is the medical note that starts your sick leave.
• INSS — The INSS is Spain's national social security institute, which receives sick-leave notes and pays benefits.

Key rules

• Specialists: In the public system you reach a specialist through your médico de familia, except for urgencias and some direct-access services.
• Priority labels: A referral is marked ordinaria, preferente or urgente, and that label sets how fast you are seen.
• Sick note: Only a doctor can issue your parte de baja, and you give your employer the copy.
• Regional differences: Apps, waits and direct-access rules differ by region, so check with your own centro de salud.

The short version

In the public system, your médico de familia (family doctor) is the door to everything else. You book a visit, the doctor orders tests or refers you to a specialist, and the same doctor signs you off work if you need it. Each region runs its own health service, so app names, waiting times and small details differ. The steps below are the same everywhere.

Step 1: Get set up and book a cita previa

You need a tarjeta sanitaria (health card) from your regional health service. You usually get it at your local centro de salud or after the social security office confirms your right to care. Tourists without coverage are not entitled to it.

Your centro de salud, médico de familia and nurse are normally assigned by your address. Some regions let you choose.

Then book a cita previa (appointment). You can do it:

• in the regional app or website
• by phone, to the centre or a regional line
• in person at the centre's reception

Some regions ask for a digital certificate or Cl@ve (the government's online ID) to use the app. If you don't have one, phone or go to reception.

A routine GP wait is often 2 to 7 days. It can be longer in busy areas. Urgent problems are seen the same day, or you go to urgencias (hospital emergency) or the PAC (urgent care point).

Step 2: Referral to a specialist

In the public system you normally see a specialist only through your médico de familia. The doctor issues an electronic derivación or interconsulta to the hospital or centro de especialidades. This replaces the old paper "volante".

Details of your appointment arrive by letter, SMS, email, phone call or the regional app. Sometimes you are told to collect them at the hospital admissions desk.

Some things don't need a referral. These are urgencias and, in many regions, gynaecology or the midwife. Some areas also allow direct access to eye care. If you already follow a specialist, they usually give you review appointments directly.

The referral carries a priority label:

• Ordinaria: routine, on the standard waiting list.
• Preferente: priority, for a suspected condition that needs faster assessment. Targets are often around 15 to 30 days.
• Urgente: very urgent, for example suspected cancer. You are seen within days to about two weeks, sometimes through a fast-track "vía rápida".

Each region sets its own targets, and they are often missed in practice. If your wait seems far too long, ask your médico de familia.

Step 3: Tests and results

Your doctor orders tests electronically.

• Analítica (blood test): done at the centro de salud or a hospital extraction unit. You are often asked to fast. Ask whether you need a booked slot or can walk in.
• Imaging (radiografía, ecografía, resonancia, TAC): scheduled by the hospital radiology department. The appointment comes by letter, SMS or phone. Reports may come on a CD or online.

Results are normally gone over with the doctor who requested them, in a follow-up consulta. Most regions also show results in the regional health app or portal. Abnormal results may bring a phone call.

Step 4: Sick leave (baja)

If you can't work, your médico de familia examines you and issues the parte de baja electronically. It goes straight to the INSS (the national social security institute). You get a paper or digital copy to give to your employer. Work-related cases go through the mutua doctor instead. Self-employed people use the same process.

How often you go back depends on how long the leave is expected to last:

• 1 to 4 days: the alta (return to work) is set at the first visit.
• 5 to 30 days: a confirmation visit every 14 days.
• 31 to 60 days: every 28 days.
• Over 60 days: every 35 days.

At each visit the doctor issues a parte de confirmación. When you recover, the doctor issues the parte de alta.

On pay, the first three days are generally unpaid unless your collective agreement says otherwise. Your employer pays days 4 to 15. After that the INSS or mutua pays.

If you go private

With private care, whether insurance or pay-per-visit, you book a specialist directly, usually within days, and no GP referral is needed. With insurance you choose from your insurer's cuadro médico (provider list). Scans, surgery and hospital stays often need autorización previa (prior approval) from the insurer, which the clinic usually arranges. Some policies have a copago (a share you pay) or carencias (waiting periods before cover starts). The public system is free at the point of use but slower for specialists. The decision block below helps you choose.

Private doctors can write prescriptions, but you generally pay for them in full at the pharmacy.

For what to do when you can't follow the doctor, see the "What if" section below. The timeline, checklist and FAQ below cover the dates, to-dos and common questions.

Choosing between options

Should you use the public system or private care for a visit?

• Public system: You are entitled to public care and want it free at the point of use; you start with your médico de familia, who refers you to a specialist, and waits are longer.

If you want free care and can accept a GP referral and longer waits, use the public system; if you want direct specialist access and quicker appointments, use private care.

Timeline and deadlines

• Book a cita previa with your médico de familia by app, phone or at reception: often 2 to 7 days for a GP slot, longer in busy areas

• Go to urgencias or the PAC (urgent care point) for urgent problems: seen the same day

• Wait for a specialist appointment after a referral marked preferente: often aimed at about 15 to 30 days

• Get the sick note (parte de baja) for a short illness of 1 to 4 days: the doctor sets the alta at the first visit

• Go to a confirmation visit while on leave of 5 to 30 days: every 14 days

• Go to a confirmation visit while on leave of 31 to 60 days: every 28 days

• Go to a confirmation visit while on leave of over 60 days: every 35 days

Checklist

• Get your tarjeta sanitaria (health card) from the regional health service before you book a visit.

• Book your cita previa through the regional app or website, by phone, or at the centre's reception.

• Give your employer the copy of your parte de baja after the doctor issues it.

• Go to each confirmation visit while your leave continues, until the doctor issues the parte de alta.

• Ask whether you need to fast before a blood test (analítica) and whether to book a slot or walk in.

• Check your regional health app for results, and ask the requesting doctor to go over them with you.

• Ask your private insurer whether a scan or procedure needs prior authorisation before you book it.

What if you cannot understand your doctor during a visit?

A short script for when you lose the thread during a public health centre visit: how to ask for repetition, simpler words, writing, an interpreter or companion, or a new appointment. For newcomers with limited Spanish.

Stop the doctor and say so

You can interrupt at any point. Doctors expect it. Do not nod along if you did not understand, because you may leave without knowing your diagnosis, your medicine or when to come back.

Phrases to use, in this order

Start with the easiest fix and move down the list only if you need to.

• Ask for a repeat: «¿Puede repetirlo, por favor?» Asks the doctor to say it again.
• Ask for slower speech: «¿Puede hablar más despacio, por favor?»
• Say you did not follow: «No he entendido bien, ¿me lo puede explicar de otra manera?» Asks for another way of explaining it.
• Ask for simple words: «¿Me lo puede explicar con palabras sencillas?»
• Ask for it in writing: «¿Me lo puede escribir, por favor?» Useful for medicine names and doses. If you cannot read a word, ask «¿Cómo se escribe?» to have it spelled out.
• Check you got it right: «¿Quiere decir que…?» Then repeat what you understood in your own words. The doctor can correct you.
• Ask for English: «¿Hay alguien que hable inglés?» Asks whether anyone on the staff speaks English.
• Ask what happens next: «¿Cuándo tengo que volver?» Asks when to come back.

If it is still not working, rebook

It is fine to stop and come back with help. Say «¿Puedo cambiar la cita?» or «Me gustaría pedir otra cita.» Both ask for a new appointment. Before you leave, ask the reception desk to note that you need an interpreter or extra time, if the centre can arrange one.

Interpreters and companions

Spain has no nationwide right to a free interpreter in the public health system. Some regions and larger health centres and hospitals offer telephone or video interpreting or an intercultural mediator. Tourist areas sometimes have English-speaking staff. To find out what exists, ask at the Atención al Paciente desk, ideally before your appointment.

You can usually bring an acompañante, such as a friend who speaks Spanish. Keep in mind:

• Your medical information is yours. The companion should be there only with your consent, and the doctor may ask to see you alone.
• A friend can make mistakes with medical words. Before any procedure that needs your consent, the doctor must be satisfied that you understand it.

Frequently asked questions

Can I see a specialist in the public system without going through my GP?

Usually no, because the public system needs a referral from your médico de familia, but there are exceptions. Urgencias (the emergency department) never needs one, and in many regions gynaecology or the midwife can be seen directly. Follow-up visits with a specialist you already see are often booked by that specialist.

How long will I wait after a preferente or urgente referral?

A preferente referral is often aimed at about 15 to 30 days, while an urgente one is aimed at within days or about two weeks. Each region sets its own targets, and they are not always met. A routine (ordinaria) referral goes on the standard waiting list.

How do I see my test results from the public system?

Most regions let you see results and reports in the regional health app or portal, but the doctor who ordered the test normally goes over them with you at a follow-up visit. Abnormal results may lead to a phone call. Imaging reports may also be given on a CD.

Do I need a referral or approval for private specialists?

No, you can book a private specialist directly by phone, app or web, usually within days. If you have insurance, many scans, surgery and hospital stays need prior authorisation (autorización previa) from the insurer, which the clinic often arranges. Some policies also have copayments or waiting periods.