2023-05-10 17:51:11
Parliament definitively adopted on Wednesday May 10 a bill for direct access to certain nurses, physiotherapists or speech therapists, a first step with limited scope following a series of protests from doctors. Designed by Macronist MP Stéphanie Rist, this text aims to facilitate access to care by relieving congestion in the offices of general practitioners. The Assembly supported it almost unanimously (226 votes to 1), following a final green light from the Senate the day before.
Under certain conditions, the French will be able, without going through their treating doctors, to consult nurses in advanced practice (IPA) who intervene in particular on certain chronic diseases as well as physiotherapists and speech therapists. “It’s a change of practice and culture”rejoices Stéphanie Rist (Renaissance).
But the initial ambition of his bill, which provoked an outcry from doctors, has been partly reduced. To go to IPAs and physiotherapists, direct access will be limited to those working in structures such as multi-professional health centers, in coordination with doctors. Contrary to what the deputies wanted, caregivers simply registered in the more flexible framework of the professional territorial health communities (CPTS), which cover around half of the population, will therefore be excluded from the system.
“A dam has burst”
A standoff opposed senators and deputies on this point, with bitter discussions in a joint committee. The deputies snatched an experiment in the CPTS of six departments, including two overseas, underlines Stéphanie Rist. For speech therapists in CPTS, direct access will remain possible. But the reduced scope of the text has annoyed some professionals: “Once once more, we gave in to mainly senatorial medical lobbying”denounces Emmanuel Hardy, president of the National Union of Advanced Practice Nurses.
The text “will only have a cosmetic effect”judge for his part Sébastien Guérard, the president of the French Federation of physiotherapists and re-educators (FFMKR), who estimates that only 3% of physiotherapists work in nursing homes.
The bill arouses much more enthusiasm among pharmacists, whose role will be increased, in particular to renew a prescription in the event of a chronic condition and to administer vaccines. A last-minute amendment permanently authorizes biologist pharmacists, in laboratories, to perform smears of the cervix as part of cancer screening.
All in all, in the eyes of the UFC-What to choose, even if“we must not have too many illusions regarding the immediate impact” of this law for patients, “a dike has jumped in terms of the sharing of skills between the doctor” and other caregivers.
“Infinitesimal progress” according to LFI
In the Senate, the rapporteur Corinne Imbert (Les Républicains) claimed a “balanced approach” making it possible to avoid « tensions » between health professionals. “We give additional keys to access care in territories like minerejoices the deputy of Nièvre Perrine Goulet (MoDem). We might have wanted to go further, but we must also listen to the criticisms of the medical world. “It’s a small step”according to deputy Jean-Philippe Nilor (La France insoumise), whose group voted for these “infinitesimal progress”.
As the senators maintained, the parliamentarians of the joint joint committee rejected the request « d’engagement territorial » doctors, which might have led some to take on more patients, to be on call or to work in a medical desert, for example. Deputy Frédéric Valletoux (Horizons) should bring a text to the Assembly in June, with the support of Renaissance, in favor of a « engagement territorial » reinforced. But it is insufficient in the eyes of the socialist Guillaume Garot, who is carrying out cross-partisan work on medical deserts, with a more restrictive bill in favor of a “real regulation of the installation of doctors”.
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