Monday, January 24

Health. Nurses, doctors, midwives … a report calls for a more balanced division of tasks

“The current medical shortage situation is expected to worsen and last for a long time,” notes the General Inspectorate of Social Affairs (IGAS), in a report published on Wednesday. This report formulates recommendations for new sharing of skills between health professionals, which could make it possible to face the difficulties of access to care.

Because the situation is critical, recalls the IGAS, based on figures from the Observatory of access to care. 64% of French people give up seeking treatment because of the delays in appointments for practitioners, 10% of the population does not have an attending physician, 72% of general practitioners admit that they cannot respond to all consultation requests no scheduled for the same day or the next day. Finally, 80% of the cantons have seen their medical demographics decline in recent years.

In addition to this medical shortage, there is also the evolution of the professional aspirations of doctors, who are now looking for a better balance between their professional and personal life. According to IGAS, 80% of liberal general practitioners under the age of 50 work in groups.

Already some evolutions

Professionals have already started to adapt, with some delegations of tasks bordering on legality. The IGAS notably cites proposals for prescriptions prepared by the nurse and signed a posteriori without any real examination of the patient by the doctor or the intervention of independent medical auxiliaries for acts for which they should in principle be supervised.

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The advanced practice, which allows nurses to exercise missions and skills devolved until now to doctors since 2018 “has not been able to develop up to the objectives set”. And only 8,700 professionals nationwide are said to have committed to cooperation protocols, which allow a health professional by way of exception to perform acts or care activities that are not normally authorized for him.

For a better sharing of skills

The Igas therefore recommends going further, in particular with the intervention of nurses in advanced practice on common pathologies identified as benign in primary care and in the general population. “This measure could now concern areas with major difficulties in accessing care, where consultation with a doctor is not possible for the patient within the timeframes and conditions necessary for proper care, but where the seriousness and urgency of the pathology to be treated do not justify resorting to emergencies, ”defends the public agency.

The reduction in the place of non-critical scheduled care in relation to acute care in the agenda of general practitioners “should make it possible to reduce response times to consultation requests and limit the foregoing or postponement to care. emergency services for patients, without reducing the daily activity of doctors, ”the report said. Pre-referral of the patient upstream by non-medical professionals to avoid going to a doctor when this is not necessary could also reduce congestion in access to care. This must be done “by reaffirming the central coordinating role of the attending physician in the course of care and the definition of the therapeutic strategy” and “within the framework of a coordinated exercise (…) by providing for a mutual obligation of information ”.

The Minister of Health, Olivier Véran, reacted to these proposals in a press release : “I am delighted with this report, which constitutes a solid basis for proposals to improve access to healthcare in all regions. We must rely more on advanced practice, which we see is not sufficiently supported within the existing framework and we must go further in the recognition of skills. They are among the most effective tools in the short term to free up the medical time we so badly need ”.

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