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Changes in Primary Care Organisation in France Health care Reform Towards multidisciplinary PC settings Best practices Prof. Marianne Samuelson Cyprus.

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Presentation on theme: "Changes in Primary Care Organisation in France Health care Reform Towards multidisciplinary PC settings Best practices Prof. Marianne Samuelson Cyprus."— Presentation transcript:

1 Changes in Primary Care Organisation in France Health care Reform Towards multidisciplinary PC settings Best practices Prof. Marianne Samuelson Cyprus European Forum of Primary care May 2009

2 January 2005 Pr M.Samuelson - Pr H.Falcoff - D.Natanson 2 France in a changing process? An important Reform A great challenge.. Towards multidisciplinary Primary care settings

3 May 2009 Pr. Marianne Samuelson 3 Three parts in the presentation < I- Un new law reorganising health care in France. Specific points concerning Primary care < II- Some experiences of organisations of multi professional PC settings < III- Analysis < adapted

4 May 2009 Pr. Marianne Samuelson 4 Some figures < doctors/340 per < Example Paris region doctors officially GPs but only 3500 practicing really general practice < So the figures are not a good indicator < Unequal distribution of doctors on the territory < distribution among specialities not adapted < adapted

5 May 2009 Pr. Marianne Samuelson 5 I- A major Heath care reform Crossing point of all expectations… < Modernising hospital < Improving access to good quality care < Defining levels of care and emphasising cooperation between professionals < Emphasizing prevention and public health < Territorial organisation of health care system

6 April 2008 Pr. Marianne Samuelson 6 1-Hospitals and private clinics < Reinforcing public utilities < Improving organisation and governance < Coordination on a territorial basis

7 April 2008 Pr. Marianne Samuelson 7 2- Improving access to care and improving quality of care < Defining levels of care < Adaptation to population needs < Organising out of hours services < Task division between doctors and other health care professionals < Coordinating cooperation between health care professionals < Link between CME and QI procedures towards Continuing Professional Development < Tacking problem of “refuse to give care”

8 April 2008 Pr. Marianne Samuelson 8 3- Prevention and public health < Defining population targeted prevention actions based on national priorities. < Keeping the balance between care and prevention < Patient education :involving patients in prevention and risk management. < A law forbidding alcohol and tobacco selling to teenagers

9 April 2008 Pr. Marianne Samuelson 9 4- A territory based organisation of health care services < A new structure (ARS), based on an integrated organisation of services including PC, hospitals… in place of the old hospital centred organisation < A new governance organisation including the state, health insurers, local authorities, and representative of patients < Definition of regional health policy based on specific health problems and setting of regional strategies

10 May 2009 Pr. Marianne Samuelson 10 ARS a new structure: “Regional agencies for healthcare” < Under the responsibility of the heath ministry < Reinforcing territorial health care policies < Acting at a regional level < Regional policy based on the work of a “regional health conference” < Replacing 7 structures: simplification of the system, multi professional representation < Acting at all levels of care/ previous hospital centred structures

11 May 2009 Pr. Marianne Samuelson 11 As a conclusion: a reform oriented towards the future < Optimising organisation of care for patients < Responsible and well educated health care professionals < Improving territorial organisation < Heath care structures adapted to there missions < adapted

12 May 2009 Pr. Marianne Samuelson 12 Specific steps forward concerning primary care in the reform < Levels of care defined for the first time < Territory based PC settings or organisational models described in the law < Definition of undeserved areas and proposal to attract young doctors to work there < General practice fully acknowledged as an academic procedure and recruitment procedure of academics in place < Task division among PC professionals mentioned < Definition of continuous professional development < adapted

13 April 2008 Pr. Marianne Samuelson 13 II- Concrete territory based PC health care settings already in place < Around one hundred multi professional PC care settings on the French territory < Population based < Focus on quality of care < Emphasising cooperation between health care providers and social workers. < Oriented toward needs of health care professionals ( preventing burn-out, preventing lack of health care professionals in underserved areas…)

14 May 2009 Pr. Marianne Samuelson 14 Different type of organisations < Under the same roof : “ maisons de sante”: professionals sharing the same premises, GP, nurse, psychologist…. < Serving a specific geographical area, or population: “ Poles de Sante”: Functional units working in close cooperation in different sites

15 April 2008 Pr. Marianne Samuelson 15 Common goals… < Serve a population, either rural or underserved suburb population : access of care, continuity, out of hour care… < PC tasks : prevention, health promotion < Focus on quality of care < Training young doctors. < Research and evaluation of practice < Experimenting new payment methods beside the main fee for service system ( capitation, pay for performance…) < Task division among different PC professionals

16 April 2008 Pr. Marianne Samuelson 16 Various type of organisations and governance of these PC settings < Some stimulated by local authorities (mayors, local politicians…) < Some initiated by professional leaders (mainly GPs….) < Some connected to regional policy < Some are very anarchic

17 May 2009 Pr. Marianne Samuelson 17 IIII- Analysis - Connections between experimental organisations and new legislation < Strengths < Weakness < Opportunities < Threats

18 April 2008 Pr. Marianne Samuelson 18 Strengths < Connection between national, regional and local policy < Meeting a real demand to improve quality of care < Emphasising cooperation among health care providers and between them and social workers. < Attracting and educating students on new organisational models adapted to PC practice < Preventing burn out of professionals < Taking more into account patients preferences and needs

19 April 2008 Pr. Marianne Samuelson 19 Weaknesses < Depending on the quality of the leadership < More focused on needs of health care professionals than on patient or population needs < Not specifically located in areas of underserved populations < Difficult cooperation with secondary care

20 April 2008 Pr. Marianne Samuelson 20 Opportunities < Attract doctors and heath care professionals in underserved areas < Reinforcing social cohesion < Definition of new task division < Better use of professional competencies of care providers within PC < Cooperation between different levels of care < Better use of guidelines

21 April 2008 Pr. Marianne Samuelson 21Threats < Only a voluntary base at the moment < Defining undeserved areas < Definition of target population for the various health care professionals < Unclear task division until now, pressure of the various professional groups < Sharing patient information: technical, administrative…. problems < Strong opposition of medical students to any obligation to settle down in underserved areas < Fear of loss of power of hospitals, and medical faculties < Disagreements between unions on payment methods < Fear of pay for performance

22 May 2009 Pr. Marianne Samuelson 22 Some figures < doctors/340 per < Example Paris region doctors officially GPs but only 3500 practicing really general practice < So figures are not good indicators < Unequal distribution of doctors on the territory < distribution among specialities not adapted < adapted

23 Merci…


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