The São Pedro da Cadeira Unidade de Saúde Familiar (USF), in Torres Vedras, opened today under private management, the first time this has happened anywhere in Portugal. The company running it, KnokHealth Portugal, will provide primary care to 5,463 residents who currently lack a family doctor, under a five-year, €2.4 million contract with the ULS Oeste, the local health authority, following a public tender.
Elsa Baião, president of ULS Oeste's board, told Lusa the unit is meant to "guarantee universal access to primary care and reduce the number of citizens without a family health team." The center will extend its opening hours from the current 8am to 4pm to 8am to 8pm on weekdays, and Knok plans to offer a 24-hour support line backed by its teleconsultation technology for registered patients who need care outside those hours.
Who's actually running it
Knok is a Portuguese telemedicine company founded in Matosinhos in 2015. It reported €10.1 million in revenue last year, up 34%, and €1.4 million in profit. Its CEO attributes the growth mainly to expanding contracts with insurers and private health plans rather than public work. Public-sector contracts make up less than 15% of its revenue. This is one of 12 public contracts the company has signed in the past two years. Co-founder and CEO José Bastos told ECO the motivation for bidding was "wanting to contribute to helping a country where 1.6 million people don't have a family doctor," and said the center will operate under SNS rules with Knok's own staff.
The existing public-sector staff at the São Pedro da Cadeira center have to be reassigned elsewhere. The law creating Model C units bars anyone employed by one, including the company's own partners or shareholders, from having held a permanent public-sector health contract during the previous three years. ECO reported that at least a nurse and an administrative worker from the center are being moved to another health unit in the county.
A Program That's Fallen Short of Its Own Targets
This arrangement is called a Model C Unidade de Saúde Familiar, or USF-C, a legal structure that has existed since 2008 but had never been used until the government revived it in September 2024, when the health minister announced plans for 20 such units across Lisboa e Vale do Tejo, Leiria, and the Algarve, regions with the worst family-doctor shortages. The original plan aimed to cover 180,000 patients in a first phase and 360,000 after 2025.
The rollout stalled. Tenders for planned units in Lagos, Monte Redondo, and Caranguejeira closed without any approved bids, and a tender for a unit in Lumiar is being contested in court by the president of the Independent Family Doctors Association, who argues its requirements are illegal and disproportionate. By May 2026, the government had cut its own target to just 60,000 patients covered by 2029, a sixth of the original goal, and as of that revision, only two USF-C units nationally, Torres Vedras and Silves, had actually been awarded contracts. São Pedro da Cadeira is the first of those two awarded units to begin operating.
The Model Has Faced Opposition Since Its Revival
The model has drawn sustained opposition since it was announced. The nursing union SEP and the CGTP union confederation have both called it a diversion of public money into the private sector and demanded it be scrapped. The Federação Nacional dos Médicos argues Model C isn't really a USF at all, structurally different from the existing Model B units, and warns it risks drawing newly trained doctors straight into private practice given ongoing SNS hiring delays. PCP has introduced a bill to eliminate the model outright, and Bloco de Esquerda called insisting on it "absurd" after May's target cut. A March 2026 investigation into a separate tender in Azambuja found contract terms, including a base price below the current public unit's cost and a unilateral termination clause with no compensation in the first year, that private operators themselves warned were risky.
The government and some in the private sector defend the approach. Health Minister Ana Paula Martins and SNS executive director Álvaro Almeida have said Model C units cost the same to run as public Model B units and can attract doctors currently working outside the SNS. The president of Portugal's private hospital association has applauded the model, and an independent doctors' union leader has praised a related private-sector arrangement covering obstetric ultrasounds in a region that had none. Martins herself acknowledged in March that the government won't manage to guarantee every patient a family doctor by 2027, and has described Model C, in her own words, as "a kind of public-private partnership."