” Direct access “, “delegation of tasks” : these expressions do not speak, or very little, to the neophyte. They are, however, at the heart of the debates that agitate – and sometimes oppose – health actors, among themselves and with their supervisory authorities; at the heart of the tensions that have been going through the medical and paramedical world in recent weeks.
Is it necessary, in order to respond to the challenge of demographic decline – for another ten years at least – among doctors, and therefore to solve the difficulties of practice and access to care, to move the lines and the perimeters of health professions? If so, how to do it, how far to go, what type of missions today assumed by doctors to delegate, and for the benefit of which other caregiver(s)?
These questions promise to rebound with the start of discussions in the National Assembly, probably this Tuesday, January 17 in the evening, in public session, of the bill “improving access to care through trust in health professionals”. . The context gives this text a particular echo: city medicine and health insurance are engaged in bitter conventional negotiations which should lead, by the end of February, to redefining the contract which binds them for five years.
Carried by a whole fringe of Renaissance deputies (and relatives) grouped around the deputy of Loiret Stéphanie Rist, the bill intends to establish a ” direct access ” patients to nurses in advanced practice (IPA) – graduates with bac + 5, and not with bac + 3 like state-certified nurses –, as well as massage therapists-physiotherapists and speech therapists. Its supporters make it a lever for “free up medical time”, at a time when the healthcare offer is not always sufficient to meet needs, when its detractors, i.e. almost all the spokespersons for liberal practitioners, are already denouncing a “two-speed medicine”, a “low cost medicine” even a “medicine without doctors”.
“Coordinated Exercise”
If the text were voted on, patients could consult these three professions “first intention” (in other words, without a visit to a doctor beforehand), on the condition, however, of a “coordinated exercise” or an exercise in a “coordinated care structure”. In the Social Affairs Committee, where the bill was adopted on January 10, Mme Rist, a rheumatologist by profession, gave details in the face of opposition deputies asking him for guarantees in this area. “These are primary care teams, nursing homes, health centers or even professional territorial health communities. [CPTS] »she explained.
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