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The Rist bill, which aims to facilitate access to patient care by modifying the scope of competence of health professionals, is strongly criticized. So, good or bad idea? The opinion of Dr Quedeville, general practitioner.
This bill, adopted by the National Assembly on January 19, 2023, authorizes patients to have direct access to nurses in advanced practice (IPA), physiotherapists or speech therapists, provided that they practice in coordinated care structures. If this law aims to fight against medical deserts, it also arouses the anger of many unions of general practitioners.
Facilitate access to other caregivers
While many doctors had already taken to the streets in early January to try to block the reform, the upper house decided to adopt on Tuesday, at first reading, the bill on improving access to care by trust in healthcare professionals.
In concrete terms, this allows patients direct access to several paramedical professionals – nurses in advanced practice (IPA), physiotherapists and speech therapists – provided that they practice within coordinated care structures.
Thus, only professionals working in professional territorial health communities (CPTS), health homes and centers, as well as health and medico-social establishments and primary care teams, are concerned.
This bill also aims to revalorize the nursing profession.by extending their field of competence to pressure from health products and services subject to compulsory medical prescription” but also “to open the profession of pharmacy preparer to anyone holding a diploma” or even of “allow pedicurists-podiatrists to prescribe plantar orthoses“.
If, on paper, the objective is noble (to facilitate access to patient care), the unions castigate and accuse the text of “endanger the health “of the population” by circumventing the coordinating function of the attending physician“.
Patients, the big losers?
For Dr Quedeville, general practitioner, there is no point in rebelling. Above all, the debate deserves to be refocused:
“The delegation of tasks is not new: it has been possible since the HPST law. But the system must continue to evolve: we cannot remain on a functioning of the 20th century. Of course, this development should not be too abrupt and it should highlight the skills and practices of doctors, which too few French people know. For example, a general practitioner can fit an IUD. And on the other hand, we are not going to “carve up” general medicine, entrusting tasks to other professions“, recalls the expert. “On the other hand, it is absolutely essential that we redefine the skills of each other. We should rethink the whole system around a round table, in a coordinated way“.
The goal? Do not forget the patients, who are ultimately “big losers today“, concludes with regret the expert.