Before you start

Empadronament (padró) certificate from your town hall, issued within the last 3 months
NIE (foreigner ID number) and passport or DNI
Either an active Social Security alta (via your employer) OR eligibility for the conveni especial OR private insurance for visa purposes
A Catalan home address (the CAP you're assigned to depends on it)

Step-by-step

1
Get registered with Social Security (or line up private cover)
If you have a Spanish job, your employer files your alta in the Seguretat Social on day one; that affiliation makes public healthcare free at point of use, and it flows automatically to CatSalut's central register. If you're applying for a Digital Nomad or non-lucrative visa, you can't rely on public cover at this stage — you must hold a private policy from a Spain-authorised insurer with no copays and no waiting periods (Sanitas, Adeslas, DKV).
Via employerWho: Employer files the alta; visa applicants buy private insurance themselvesAlta effective from the contract start dateFree (Social Security contributions); private policy ~€50-150/month
2
Do your empadronament at the ajuntament
Register your address on the municipal padró at your local OAC and obtain the certificat d'empadronament. This is the hard prerequisite for the TSI: the certificate must be dated within the last 3 months. Without a padró you can still be treated in an emergency, but you can't get a TSI or choose your own GP.
In personWho: You (each family member registers individually)Same day to a few weeks for an appointmentFree
3
Register at your CAP and request your TSI
Go to the CAP for your address (or one you choose under lliure elecció) with your padró certificate and NIE/passport. Fill in the TSI application. CatSalut assigns you a primary-care team and a metge de família — your GP and the gatekeeper who refers you to specialists and hospitals. You get a temporary access code by email while the physical card is posted to you. You can also apply online via tramits.gencat.cat.
In personWho: YouProvisional access within days; physical card mailed within a few weeksFree
4
Activate La Meva Salut and save the right phone numbers
Set up La Meva Salut, the official Catalan health portal/app, using the CIP code on your TSI. From it you book GP visits, see test results and your medication plan, and use eConsulta to message your doctor (not for emergencies). Save 061 Salut Respon for urgent medical advice and 112 for life-threatening emergencies. For after-hours urgent care, a CUAP (primary-care urgent centre) is the alternative to a hospital A&E.
Mobile appWho: YouSame day once you have your CIPFree

Documents you’ll need

Certificat d'empadronament (padró) issued within the last 3 months
NIE and passport (or DNI for Spanish/EU nationals)
Proof of Social Security affiliation (alta) if employed, or conveni especial enrolment
TSI card with its CIP code (issued at the end of the process; needed for La Meva Salut)

Things most newcomers don’t know

Barcelona's public health system is CatSalut, a fully devolved Catalan service — not Madrid's SERMAS.

Health is a devolved competence in Spain, so the issuing body, the card (TSI), the app (La Meva Salut) and even the terminology differ by region. Guides written for Madrid (SERMAS) describe a different bureaucracy and send newcomers to the wrong agency.

Source: CatSalut (Servei Català de la Salut)

No padró, no TSI. The empadronament certificate (dated within 3 months) is the gate to the whole system.

CatSalut requires proof of registration in a Catalan municipality to issue the card and grant the right to choose a doctor; it also fixes which CAP and GP you're assigned to. People who skip the town-hall step get stuck before they can register at a CAP.

Source: CatSalut TSI page

Your metge de família at the CAP is the gatekeeper for everything, and La Meva Salut is how you actually book and message them.

Specialists, hospital referrals and most prescriptions all flow through your assigned GP. Newcomers used to booking specialists directly need to go through primary care first; the app (with your CIP) is the practical front door.

Source: CatSalut La Meva Salut

Catalonia has its own pay-in route, the conveni especial — but only after one year of residence.

For legal residents without Social Security cover it's ~€60/month under 65 (€157 if 65+), letting long-stayers buy into CatSalut instead of private insurance. But the one-year wait and limited pharmacy coverage catch people who expect immediate cheap access — you still need private cover for year one.

Source: CatSalut conveni especial

Common mistakes to avoid

Following Madrid/SERMAS instructions: the agency, card application and app are different in Catalonia (CatSalut, the TSI and La Meva Salut).
Assuming private travel or home-country insurance qualifies for the Digital Nomad or non-lucrative visa: consulates require a policy from a Spain-authorised insurer with no copays and no waiting periods.
Letting the padró certificate go stale: if it's older than 3 months the CAP will refuse the TSI application.
Trying to use eConsulta or La Meva Salut for an emergency: use 061 Salut Respon for advice or 112 for life-threatening emergencies, or go to a CUAP/A&E.