Half of First Specialty Appointments in Portugal's Health Service Miss the Legal Time Limit, With Penafiel and Matosinhos the Worst Performers

Half of the first hospital specialty appointments in Portugal's public health service are now taking place after the legal deadline has already passed. Between January and May 2026, 50.2% of all first outpatient specialty consultations in the Serviço Nacional de Saúde (National Health Service, or SNS) were held outside the Tempos Máximos de Resposta Garantidos (Maximum Guaranteed Response Times, or TMRG), according to figures from the SNS Transparency Portal analysed by the newspaper Observador. It is a marginal improvement on the same period of 2025, when 51.5% ran late — but it still means one in two patients waits longer than the law allows to see a specialist for the first time.

The national average hides enormous gaps between hospitals. The worst performer is the Unidade Local de Saúde do Tâmega e Sousa (Local Health Unit, based in Penafiel and Amarante), where 73.6% of first appointments breached the deadline. It is followed by the ULS de Matosinhos, home to the Pedro Hispano hospital, at 67%, and the ULS da Região de Leiria at 65.5%. The Médio Tejo unit (Tomar, Abrantes and Torres Novas) and the Oeste unit (Torres Vedras, Caldas da Rainha and Peniche) rounded out the bottom five, both above 64%.

Where the system works — and where it does not

At the other end sits the Hospital de Cascais, the country's only public-private partnership, where just 11.9% of first appointments ran past the limit. The cancer centres in Coimbra and Porto — the IPO de Coimbra (13.6%) and the IPO do Porto (16.4%) — also performed strongly. The contrast is a reminder that the failure is uneven rather than universal. Even so, in the IPO de Lisboa, 46.5% of first oncology appointments were held late, a worrying figure for a specialty where the legal window is as short as seven days for the most urgent cases.

The TMRG set a 120-day ceiling for a routine first appointment, 60 days for a priority case and 30 days for the most urgent. For suspected or confirmed cancer and heart disease, the limits tighten to as little as 30, 15 or seven days. Across the SNS, 892,445 first specialty consultations were carried out in the first five months of the year — a slight fall of 0.8% on 2025 — even as demand keeps climbing. By the end of 2025, 1,056,223 people were waiting for a first appointment, 17% more than a year earlier.

The hospitals blame a shortage of doctors and rising referrals from health centres; several have opened Saturday clinics to claw back capacity. Xavier Barreto, president of the hospital administrators' association APAH, argues that roughly three-quarters of doctors' time goes to follow-up visits, and that stable chronic patients could be monitored by nurses or even in pharmacies. That measure was written into the government's Health Emergency Plan but stalled amid resistance from doctors.

What This Means for Expats

• Where you live matters: Access to a first specialist appointment depends heavily on your local health unit. If you are in the Penafiel, Matosinhos or Leiria catchments, expect long waits; Cascais and the cancer centres move faster.
• The public deadline is a right: The TMRG are legal maximums. If you breach them, you can request a "vale cirurgia"-style referral or ask to be treated elsewhere in the SNS — keep your referral date on record.
• Private cover fills the gap: Many residents pair the SNS with private insurance or a health plan precisely to skip these first-appointment queues for non-urgent specialties.
• Urgent cases still count: Cancer and cardiac referrals carry the tightest deadlines. If yours is slipping, escalate through your GP rather than waiting silently.

The numbers are inching in the right direction, but with demand growing faster than supply, the waiting lists look set to lengthen before they shorten.