Fighting against medical deserts and making practitioners more responsible without irritating the sector: a sensitive bill on access to care was definitively adopted in Parliament on Monday despite the disappointment of the left, which considers the measures insufficient. A final vote in the Senate, a few days after that of the National Assembly, put an end to the lively debates that began in June on this bill aimed at improving access to care in the territories.
The text by Horizons MP (presidential majority) Frédéric Valletoux was adopted by 241 votes to 81. The fine line was thin for this future law, supported by the government: the discussions took place in a tense period for the doctors' unions, which are trying to negotiate an increase in consultations with the Health Insurance. They maintained a high level of vigilance on the examination of the text, fearing coercive measures that would have reinforced their mistrust of the executive.
To meet health needs, "it would be appropriate to give us means more than obligations," responded the Regional Union of Health Professions - Liberal Doctors of Île-de-France, evoking some "vexatious articles". Several of the practitioners' demands were nevertheless heard: no measures to regulate the installation of doctors were retained in the version submitted to the vote, to the great displeasure of a part of the left that wanted to force professionals to settle in medical deserts.
Parliament has chosen "trust rather than coercion," said Les Républicains senator Corinne Imbert, who is in charge of the bill in the Senate. "It is certainly a partial text that does not respond to all the ills of the health system", but it is "pragmatic and concrete" and will make it possible to "decompartmentalise, territorialise" the system "and give more oxygen to those who take care of our fellow citizens", stressed Frédéric Valletoux after the adoption in the Assembly.
Breaking down silos
Under the watchful eye of practitioners, Parliament has nevertheless taken up a tense issue, that of the distribution of permanent care: the burden of night and weekend shifts will be rebalanced between the public hospital sector and private clinics. The mechanism provides for a great deal of freedom of organization between institutions, but in the event of a deficiency, the Regional Health Agency (ARS) will have enhanced power to designate certain institutions as a last resort.
The profession will be vigilant about the implementing decrees on this point: "What could make us angry is that we re-establish a certain form of obligation," explains Patrick Gasser, president of the main union of specialists Avenir spé. "It would put the conventional negotiations in the air."
This text "goes in the right direction" but it remains "in the middle of the ford", explained Lamine Gharbi, president of the Federation of Private Hospitalization (FHP). "To promote full cooperation between health actors, and to move from a culture of supply to a culture of demand, we need to renovate the current public hospital service," he added.
Another hot spot is the automatic membership of doctors in territorial health professional communities (CPTS) that are supposed to facilitate coordination at the territorial level and was not retained in the final version. The text also broadens the skills of nurses with the creation of the status of "referring nurse" who will be responsible for monitoring and renewing prescriptions for chronic patients.
Health Minister Aurélien Rousseau welcomed "an ambition, that of accelerating the decompartmentalization of our health system with concrete solutions to improve access to care." A formula that did not convince part of the left: the Socialists and Communists voted against it in the Senate. "We are condemned to patches" without "the shadow of measures to regulate the installation of practitioners", denounced the communist Céline Brulin.