2024-06-10 10:06:57
Véronique Hamayon, President of the Sixth Audit Chamber, Franck Devulder, President of the French Federation of Medical Trade Unions (CSMF), Daniel Gee, President of the National Nurses Federation (FNI) Daniel Guillerm and David Guillet, President of the Federation. On June 4, the Territory Health Professional Group (FCPTS) was invited to discuss “ How to halt the decline of primary care in France? » Worth it healthy counterpoint. An hour of rich discussion at a time when inequalities in access to health services are worsening.
The average delay in accessing primary care is lengthening and finding a primary care physician is becoming more difficult… Observations of the Court of Auditors in its report Report released on May 13 Severe (1). It confirms the BVA’s exclusive findings published during the Contrepoints de la Santé debate on 4 June. 60% of French people Acknowledging that it has been difficult to get an appointment and benefit from primary care over the past six months… However, the stakes are high as this is the “first contact” with the healthcare system and if deficiencies exist, this It’s the patient’s entire care pathway and it’s the health system that’s at risk.
things are getting worse
” this There is indeed a problem »”, confirmed Véronique Hamayon, President of the Sixth Chamber of the Court of Auditors. At the base “Looking at a certain amount of data, we conclude that despite many tools, the situation is not improving” Over the past fifteen years, through various successive health laws “Working to halt the growing difficulty in accessing primary care.” on the contrary, ‘We see things getting worse’ especially ‘Growing inequality between regions’she concluded.
this Private doctors and health insurance companies sign new agreement on June 4 Nor does it really contain strong measures to halt this decline. There are some packages available for Advanced consultationof Installation aids…but not enough to revolutionize access to primary care or to effectively combat an aging population, the rise of chronic disease and the decline in caregivers.
Global strategic challenges
“Every tool that is independent of other tools may be related” but will remain “Partially invalid” No font “Global strategy, global vision, structured policies with quantified targets and Metrics for measuring the results achieved”, Ms. Hamayoun continued.
fact, “Some of the tools are interesting and starting to yield results”including establishing medical assistant Who, full time, “According to Cnam data, we can save up to 13% of doctors’ medical time on average” : “This is a smart idea that needs to be disseminated more widely; but (…) we need to target them more, because today the recruitment of assistance for medical assistants is indiscriminate, regardless of the region in the area and the doctors they target how……”
800 CPTS to date
What do you give? Regional Professional Health Communities (CPTS) ? Why can’t they build an effective primary care system, even though it’s one of their core priorities? David Guillet, president of the CPTS federation, procrastinated. “The first CPTS signed an interprofessional standing agreement at the end of 2019” – Four and a half years ago – since then, “There was a health crisis that slowed the momentum a little bit”he pointed out, no matter what “From an administrative perspective, because there is a dynamic of horizontal coordination on the ground”.
Nonetheless, today we confirm “800 CPTS are at various stages of development, covering 84% of the country’s population”, he pointed out. among them, “555 signed regular agreement” Thereby there is “Contracted with Health Insurance and District Health Boards for a territorial health project aimed at improving people’s access to care”. Therefore, he believes that “Give CPTS time to survive and develop this culture of access to primary care because it takes 5 to 7 years for CPTS to produce something”. so long? Yes, “Because it’s a new culture” : this “Health professionals are trained in silos with little transversality in approach”.
Obtain a Graduation in Nursing
However, he said initial results were already showing. “In my CPTS in southwest Mayenne, we provide 700 unscheduled care slots per week to around 20,000 residents, which is already a great feat; 99% of doctors are signed up and a local hospital Operates through CPTS »
On the other hand, for CPTS that doesn’t work, “I don’t think we should put it on trial: we need to look at why this or that area lacks vitality: sometimes these are human stories, sometimes organizational stories…” Some “Flaws may arise from the fact that CPTS is still young, the professionals involved in it lack investment, or because they are not understood.” In addition, I would like to add: “There is a gradation of access to care between first call, second call and third call; if everyone is on different floors doing their job, I guarantee you that the routes being organized will be smoother”.
Nursing Education Reinvention
FNI President Daniel Guillerm shared these findings. “The merit of the Court of Auditor’s report is that it highlights the real problem: providing resources to stakeholders, no matter who they are, no matter which department they belong to, but without guarantees of results and without measurement of impact. » we are “In the rather specific context of the epidemiological transition”he continued, “An aging population coupled with a surge in chronic diseases” : “We have a wall in front of us, we know it will take time to train doctors… At the same time, what do we do? (…) We don’t have a magic wand, but we nurses can be part of the solution”exist “Increase” Professional privileges and promotion through “direct interview” liberal nurse “part” For example, their activities.
The timing is right. “Today, we are redesigning our diploma” WHO “will lead to nursing law Promise before the end of the year”, Mr. Guillerm recalled that although the law of December 27, 2023 already provided for Reference nurse status Improve coordination and access to care for patients with chronic conditions. The delegation of tasks and skills, as well as cooperation agreements between professionals and coordinating implementing agencies (CPTS, health homes, health centers, etc.) to promote care, also appear among the “levers for action” of the DGOS aimed at improving access to care the entire national territory.
Attractiveness of the Health Professions
lament “Public policy led to an increase of 7,000 medical students in training in the late 1970s” have “3000 per year”CSMF President Franck Devulder insists that it is necessary “strengthenThe appeal of the profession of personal physician » He recalled that who worked “More than 50-55 hours a week”.
He also suggested giving live actors a “Freedom of organization in the territory” : “Today, in a medical desert, you can’t find a young general practitioner setting up shop without a cardiologist, a nephrologist, a gastroenterologist… because he tells himself that he has to manage from A everything of. Professional nursing teamFor two years, ARS has been through one hell of an obstacle course. Let ARS and URPS eventually become corresponding parts of urban organizations and play the role of urban organizations. outright policy. Let’s find out where we have some generalists and specialists left and see how we can improve their daily lives. Then we will take a big step forward. »
“Regional Organization Project”?
The Court of Audit relies on “Regional project to organize primary care”. fact, “If there is a need for a national framework with national objectives, all this has to be implemented at the territorial level, hence the idea of establishing a territorial organization””, assures Ms. Hamayoun. Target: No “Let each participant organize primary care in an area according to his own feelings and according to his own goals; everything must be coordinated and serve a common goal ”. And if “The ARS must lead and then primary care must be organized at the departmental level and then provided in each region, living area or CPTS”.
(1) The proportion of patients without an attending physician may be as high as a quarter of patients (i.e. twice the average), and in some areas the rate of emergency room visits without any particularly serious condition may reach 40%, e.g. For example, reports from the Ardennes region indicate.
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