Support the development of nursing centers in the provision of local care

2023-09-28 14:35:57

In this report, the General Inspectorate of Social Affairs (IGAS) underlines the interest of nursing centers (CSI) which deserve to be better valued, to the extent that they constitute real support for prevention and access to care in the territories.

The 520 nursing care centers (CSI) installed in France at the start of 2022 are health centers composed almost exclusively of employed nurses who provide care in patients’ homes. They represent less than 5% of the provision of local nursing care nationally, but almost 50% of the offer in their municipality of establishment (75% in areas with very little provision for local nursing care), which which demonstrates their good integration into the local ecosystem of health and medico-social actors.

However, these centers often experience great difficulties, first in terms of recruitment, due to not having been able to benefit from the “Ségur” bonuses, then increasing financial difficulties, accentuated by the financial revaluation of amendment 43 of the collective agreement. of the home help branch decided in 2021 (salary increase of 15% on average).

A third of CSIs (31%) encounter significant difficulties (following amendment 43) while they are located in vulnerable territories in terms of desertification (under-resourced nursing zoning, political district of the city, rural revitalization zone) or in going from becoming one.

What conclusions and recommendations?

The report recommends, in the very short term, emergency financial support for CSIs in difficulty and, in the longer term, the adoption of a series of measures capable of ensuring their sustainable development. The usefulness of these centers has been demonstrated and deserves to be better valued, to the extent that they constitute a real support point for the deployment of government health priorities (health prevention, equal access to care in the territories in particular).

D’après l’article L.6323-1 du code de la santé publique, « les centres de santé sont des structures sanitaires de proximité, dispensant des soins de premier recours et, le cas échéant, de second recours et pratiquant à la fois des activités de prévention, de diagnostic et de soins, au sein du centre, sans hébergement, ou au domicile du patient. Ils assurent, le cas échéant, une prise en charge pluriprofessionnelle, associant des professionnels médicaux et des auxiliaires médicaux. (…) Les centres de santé sont ouverts à toutes les personnes sollicitant une prise en charge médicale ou paramédicale relevant de la compétence des professionnels y exerçant »
Le code de la santé publique met ainsi l’accent sur le caractère à la fois « de proximité » et collectif de l’exercice professionnel en centre de santé. Les articles L6323-1-1 et suivants précisent notamment :
- le caractère facultatif des missions complémentaires des centres de santé (actions de santé publiques, contribution à la permanence des soins ambulatoires ou à la mission de soutien sanitaire des forces armées, lieux de stages, pratiques des IVG…) ;
- leur gestion par des établissements à caractère non lucratif ou lucratif (article L6323-1-3), le principe de réaffectation des bénéfices du centre à son bénéfice ou à une structure à but non lucratif du même gestionnaire (article L6323-1-4) ;
- le principe du salariat des professionnels de santé exerçant dans les centres (article L6323-1-5), comme de la possibilité de bénéficier de la participation de bénévoles ;
- la possibilité de leur participation aux communautés professionnelles territoriales de santé (CPTS) (article L6323-1-6) ;
- l’application du mécanisme du tiers payant (article L6323-1-7) ;
- l’obligation d’élaboration d’un projet de santé (article L6323-1-10

Assessment of the economic situation and development prospects for nursing centers in the provision of local care, Carole LEPINE and Bruno VINCENT, General Inspectorate of Social Affairs, November 2022

1696198378
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