PRESS RELEASE

13 May 2024

Thematic public report

TERRITORIAL ORGANISATION OF PRIMARY

CARE

Defined by article L. 1411-11 of the French Public Health Code (CSP), primary care includes

not only care provided by general practitioners and some specialists who can be accessed

directly, but also advice from pharmacists, nursing care, physiotherapy, dental care and

treatment provision by speech therapists and psychologists. In France, access to this type of

care is becoming increasingly difficult, to the point where part of the country has been

described as a "medical desert". The importance of this care - sometimes also referred to as

primary or first-line care - has nevertheless been recognised and promoted for over forty

years by the World Health Organization (WHO) and the Organisation for Economic

Cooperation and Development (OECD). In France, it has been enshrined in a number of laws

designed to improve coverage of needs by making the healthcare system more efficient. For

these reasons, the financial jurisdictions have continued their examination of public support

for the organisation of primary care, which began in 2023 with an analysis of support from

local authorities.

Disappointing developments in access to healthcare

The supply of healthcare is the result of a complex evolution in the number of healthcare

professionals and changes in their behaviour. Demand, meanwhile, is increasing due to the

growing frequency of chronic pathologies, which leads to a greater volume of so-called

"scheduled" care. Patients are also finding it increasingly difficult to find a response to their

requests for so-called "unscheduled" care, due to overcrowded diaries and changing demands.

These tensions are reflected in a number of quantitative indicators: the average time taken to

obtain an appointment with a doctor is getting longer, the proportion of patients without a

general practitioner is increasing, and the proportion of doctors no longer taking on new

patients is also on the rise. Among patients without a GP, the proportion of the most

disadvantaged is increasing. Geographical inequalities in the distribution of healthcare

professionals are worsening. In some regions, the proportion of patients without a GP can

represent up to a quarter of all patients, and the rate of visits to A&E for non-serious incidents

serious can be as high as 40 %.

Uneven and poorly targeted measures

Since the late 1990s, various plans and measures have been introduced to improve the

organisation of primary care. The initial emphasis was placed on the "pivotal" role given to

"referring" GPs and then "attending" GPs. “Care networks" have been set up to facilitate this

referral and share the burden of patient follow-up. Various "plans" have subsequently sought

to increase the assistance given to healthcare professionals to encourage them to set up, or

stay in, areas with a scarcity of doctors. From 2010 onwards, the aim has focused more on

developing care structures such as multi-professional health centres or medical health centres.

At the same time, various measures have been taken to entrust primary care professionals with

support tasks, but they have remained uneven. The strategy outlined at national level has

reaffirmed the vital need to adapt primary care, but this has only rarely been translated into

measurable operational objectives. There is therefore a stark contrast between the ambition

of the measures announced and the "feeling of abandonment" experienced by the inhabitants

of the most vulnerable regions. The sheer number of aid schemes and their instability over time

make it very difficult to consolidate the overall results. Although there are some positive

developments, the aid provided is proving ineffective, judging by its low impact. Furthermore,

the possibility for professionals from different professions to organise structured cooperation

is not sufficiently put into practice.

A public policy that needs to be structured based on expected results

The detailed analyses included in the three regional reports help to make the avenues for

change put forward in the national report more practicable. The diversity of support granted by

local authorities, in addition to national schemes, can help to kick-start a dynamic, but it is not

enough. An analysis of the work carried out by the Regional Health Agency (ARS) and the Local

Sickness Insurance Fund (CPAM) in the Aveyron department has shown that there is still a

shortage of doctors in several catchment areas. To consolidate the progress that has already

been made, an overall strategy is essential, which must then address the problems identified in

each region. The definition at departmental level of territorial projects for the organisation of

primary care is worth expanding. These projects, placed under the aegis of the departmental

delegations of the ARS and the CPAM, should be clearly driven by a logic of results, based on a

very selective battery of "alert" indicators. National authorities should

support this approach,

guiding and evaluating its progress on a regular basis.

To support these regional projects, aid must

be targeted at the most vulnerable patients and the areas with the greatest shortfalls. More

proactive measures are essential, as is the deployment of hospital health centres or secondary

medical practices. These would be supported by an obligation to practise part-time in medically

underserved areas, in return for doctors being given the opportunity to move to areas with

better medical provision.

Read the report

PRESS CONTACTS:

Julie Poissier

◼

Head of Media & Social Networks

◼

T

+33 (0)6 87 36 52 21

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julie.poissier@ccomptes.fr

Sarah Gay

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Press Relations Officer

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T

+33 (0)6 50 86 91 83

◼

sarah.gay@ccomptes.fr

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