General practitioners, medical assistants, pricing… what to remember from Macron's announcements on health

Medical deserts, hospital crisis… the plans follow each other, the problems survive them.

Did Emmanuel Macron's "very concrete" announcements live up to the promised "refoundation" of a "breathless" health system?

The head of state was eagerly awaited during his wishes to caregivers, this Friday in a hospital in Essonne.

And he was clear on the subject: we must "completely rethink our collective organization".

The Head of State wants to think about it “in a cooperative way” between “administrative staff and caregivers, caregivers and paramedics, city and hospital”, he listed.

The idea is to "limit unnecessary acts" with, in particular, "better prevention".

Here are the main measures he wants to put in place to try to achieve this.

Fight against medical deserts

According to the Ministry of Health, 5.7% of French people lived in an "under-dense area" of general practitioners in 2018. Official figures undoubtedly largely underestimated: the Minister Delegate for Health Professions, Agnès Firmin Le Bodo , repeating in recent months that “87% of the territory is considered a medical desert”.

The situation is not about to improve.

The profession is going through a demographic "trough" which will not be caught up before 2035, the time that the abolition of the "numerus clausus" at the entrance to medical studies produces its effects.

“We will have 80,000 general practitioners in 2025”, warned Emmanuel Macron this Friday.

So "we are going to have to reorganize, decompartmentalize", he said, wishing, for this, to set up National Councils for Refoundation (CNR) in all territories in order to "build a roadmap" to lead on solutions against medical deserts”.

He wants “reference teams for the 600,000 French people who have chronic illnesses (…) by the end of the year”.

And in the absence of a attending physician, the "care access service (SAS) will be generalized", he promised.

The answer to generalists

To respond to the anger of general practitioners - who are demanding a doubling of the basic consultation, from 25 to 50 euros - Emmanuel Macron seems to be trying a double blow by betting on "incitement".

“We are going to better remunerate the doctors who provide ongoing care and take on new patients”.

"We are moving away from fee-for-service funding to mission-based funding", he concluded.

Another problem pointed out by GPs in recent weeks: the time spent on administrative work.

On the subject, Emmanuel Macron assured that he was going to increase the hiring of medical assistants, in order to "free up medical time".

"We must go from 4,000 to 10,000 by the end of next year," he said, assuring that the state would "increase funding to do so".

Reorganize studies

For the Head of State, we must review “the organization and operation of our studies”.

A project that he wishes to “launch and finalize in the summer”.

In particular, he wants to prevent students from stopping along the way.

“About 30% of students stop during training and 15% fail at the end.

So when we open 100 positions, we have 55 arriving in the field”.

The president therefore wants "a more empowering system after graduation", he announced, without specifying how many years would be due or which professions would be affected.

Improve working conditions

Beyond recruitment, the challenge for the hospital is "to keep the caregivers who are already there", recognized Emmanuel Macron, while at the Paris Hospitals, for example, the nursing workforce has shrunk by 10% in four years, increasing the rate of closed beds to 16%.

The financial increases from the Ségur de la santé in 2020 were not enough.

All the professionals insist on the need to improve working conditions and life at work.

“I know the collective exhaustion, and the impression of going from one crisis to another”, assured Emmanuel Macron in front of the caregivers of Corbeil-Essonnes.

Similar to what he wants to do for GPs, the president has said he wants to increase the hiring of medical assistants in hospitals too.

In order to maintain attractiveness, he also wants “better consideration of training”, in particular for the remuneration of caregivers throughout their careers.

"We must rebuild a system more consistent with the reality of everyday life", by "adapting the schedules" at the level of the services in particular, he also pleaded, hoping that by June, each hospital will have started discussions to reorganize.

Emmanuel Macron also put forward the idea of ​​setting up doctor/administrative tandems at the head of establishments.

Funding in hospitals

Fee-for-service has "created a lot of dysfunction in the system", judged the head of state in front of the caregivers of the Corbeil-Essonnes hospital.

"We must get out of activity-based pricing from the next social security financing project", moving to "remuneration based on public health objectives" negotiated "at the scale of a territory", he announced.

Read alsoChildren “daily in danger”: the shock letter to Emmanuel Macron from 4,000 pediatric caregivers

emergency crisis

It is necessary “to open the site on the remuneration of night work”, in order to allow the continuity of care.

Emmanuel Macron wishes, for this, to set up a reward system for the establishments which ensure this continuity.

“The emergency measures planned until March will be maintained,” he also assured.

Fight against cyberattacks

Emmanuel Macron took advantage of his visit to the Corbeil-Essonnes hospital, which suffered a cyberattack last September, to discuss the subject.

“You held on.

Everywhere you had to resume manual work, you continued with even more constraints to provide care”, he first recognized, before ensuring that “we have started to reinvest (…) in the resistance to cyber attacks”, without giving further details.