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Dr Gérald Kierzek (Medical Director)
On the occasion of his wishes on January 30, 2023, the Minister of Health and Prevention, François Braun, presented his roadmap for the coming year, structured around 10 objectives aimed at ensuring the future of our health system. In response, Dr. Gérald Kierzek, medical director of Doctissimo, gives us his point of view, without language of wood.
It is a whole vision of the future of the health system that the Minister of Health and Prevention, François Braun exposed on January 30, during his wishes dedicated to the living forces of health. Wishes that took the form of a roadmap with 10 key objectives for “mark a turning point”. But if the concept is promising on paper, it lacks concrete progress according to Dr. Gérald Kierzek, medical director of Doctissimo.
Guaranteeing all French people suffering from a long-term illness (ALD) access to a general practitioner
François Braun emphasizes that more than 600,000 patients with long-term illness (ALD) are deprived of regular follow-up. Under the aegis of Health Insurance, he announces that ae “a steering body will be set up at the national level in the coming weeks with all the players”. All those concerned will be contacted by the end of June. At the same time, the ministry will work on the development of multi-professional treatment teams, to guarantee local support around the treating doctor, also giving room to peer helpers.
“But there are no more attending physicians. We are at a stage where liberal general practitioners are looking for positions as employees of occupational physicians! To retrain. To re-motivate them, we must ensure in priority that they settle, that the careers are attractive and then naturally there will be better access for all” tempers Dr Gérald Kierzek.
Giving back medical and caring time, in town and in the hospital
François Braun wants to accelerate the decompartmentalization of the health system, continue to strengthen the workforce and mobilize all the levers that save time in care, at the service of patients. “While medical demography will continue to deteriorate in the coming years, we have an absolutely major challenge here: to allow caregivers to focus on the heart of their profession”. He thus announces to increase the number of medical assistants and to identify, in the hospital, the logistical, technical and administrative support to be deployed as close as possible to the services. But also “strengthen coordinated exercise (…) and mobilize ourselves so that isolated exercise becomes the exception”.
For Dr. Kierzek, the problem is not well identified: “Yes, there is administrative work, but the problem is that currently we no longer have the opportunity to simply do medicine, because what we do is mainly slaughter with a volume important consultation. There are no more medical correspondents, no more specialists… It is not a waste of time nor a problem to call a cardiologist or a dermatologist for his patient and talk about his case; it is even medicine. The problem is the shortage and therefore the loss of time to find it”.
Allow continuity and permanence of care throughout the territory
The ambition is to guarantee to all, without exception “the possibility of accessing a doctor during the day, but also in the evening, on weekends and on public holidays”. The achievements made on the preliminary call to 15 before moving to the Emergency Department must be consolidated, which involves securing the Medical Regulation Assistants, announced the Minister. A plan to develop the attractiveness of this profession and increase their recruitment will be presented by the end of the first half of the year.. “And a tour of France of Access to Care Services will be undertaken by the end of February”. This work will also identify the means of consolidating some specialized courses in the SAS, such as psychiatry, geriatrics or pediatrics. to better meet these specific needs.
“Betting everything on 15 cannot be the only answer. The Samu is already saturated and it is only directing patients to provide them with an answer: ambulance, doctor at home, etc. If there are more doctors for go to your home, if there are no more emergency services – because they are closed and there is no longer any local network -, what will the 15 respond to? of care with 3 levels of response: ambulatory medicine, the hospital with its local emergencies and finally the specialized regional hospital. Otherwise, the SAMU (or the SAS) will be the next service that will explode” recalls Dr. Kierzek.
Improve the quality of life in the hospital and stabilize the teams
Restoring confidence in the future to hospital professionals is a major challenge, which involves remuneration but also through “the renewal and diversity of practices”. This improvement in the quality of life and work involves giving new responsibilities and career prospects, a new organization of caregivers’ working time, limiting overtime, giving more stability to schedules. A plan will also be deployed in favor of service managers, and in particular health executives.. “We must continue to strengthen the head of department/health executive pair, through training but also through modern tools for leading work groups“.
“We must above all stop mistreating all medical personnel, retorts Dr. Kierzek. VSis to say to have plethoric administrative directions, namely people who are disconnected from caregivers. Caregivers must be put back in charge, as in military hospitals, and bet on the actors in the field, in particular the heads of service. Administrative departments and doctors must work together”.
Train more caregivers and train them better
“The year 2023 will be the year of nurses, the year of clarified perspectives”, noted F. Braun, mentioning several important measures concerning in particular the securing of student pathways and the reengineering of training and the increase in the number of nurses in advanced practice (with the objective of 5,000 APNs in activity by the end of 2024) and the recognition before the end of 2023 of advanced practice for specialized nurses.
“Training better and more? For the time being, let’s remember that we have people who failed in their first year of medicine who go abroad, and that there are no more competitions for nursing school. There is still a total disconnection between places of training and practice. And then I’m not sure that the problem is quantitative: caregivers and nurses, we have them. The challenge is above all to keep them!”.
Create a shock of attractiveness in the territories and facilitate the daily life of caregivers
Housing, transport, parking, security or even childcare, it is a question of “provide new and innovative solutions” at the territorial level, to facilitate the daily life of caregivers.
“The shock of attractiveness, with a low salary, does not provide accommodation. What is needed is to better pay people and value them. This formula already used in Ségur has not given anything. ..”
Turn your back on accounting logic and review the financing of the health system
“We are going to get away from the logic of supply and profitability, and better support the issues of public health, cooperation at the territorial level, prevention and responsibility vis-à-vis the populations. Our objective is clear: get out of “all T2A”said the Minister of Health.
“Note that these are the same people who were at the helm and advocated accounting logic” analyzes Dr. Kierzek. “I think above all that you have to trust the doctors. When there is a need for an examination, we must be able to do it and that it be reimbursed. When there is no need for it, we do not do it. , point”.
Ensuring that health is accessible to all
While progress has made it possible to improve everyone’s access to certain types of care (dental care and hearing aids, for example), the Ministry intends to “stage 2 of 100% health. At the same time, the moderation of excess fees, such as the work on the deployment of third-party payment, are among the issues that should not be lost sight of.”
“In fee overruns, there are sometimes abuses. But it is above all the acts that are undervalued. We must stop this fee-for-service logic, but have remuneration methods based on health needs (when we need a doctor or a nurse, in a place, it is better to pay him/her ), the arduousness of the specialty and the level of responsibility… Overruns are often there to compensate for unfair remuneration” indicates the doctor.
Collectively assume a new ambition on prevention
For François Braun, prevention must be “a marker of the overhaul” of the health system. This will result in particular in the realization of prevention appointments, in particular for people furthest from health.
“Yes, yes and yes, but prevention should not be considered to the detriment of care. Then prevention is not just about vaccines or physical exercise. But, for example, let’s think about diabetes, or the prediabetes which concerns millions of people, one could imagine a real prevention by measuring the sugar level or theglycated hemoglobin in the blood of those at risk, and reimbursing that.”
Make 2023 an important year for research and innovation
In conjunction with the Minister of Higher Education and Research, the Minister of Health wants to carry out “proactive and resolute actions to develop health research, and to restore France to the place it should never have lost among the most successful countries in this area”. With notably, “the creation of the Health Innovation Agency, which has been gradually taking shape since the end of 2022. This is also the meaning of the France 2030 Plan, the purpose of which is to invest proactively in projects innovative and transformative”.
“It looks like a big consultant plan,” let the doctor hear. “We have plenty of agencies; but here again, we have administrators or administrative doctors at their head, who have become more technocrats than caregivers… It makes no sense. We are creating a millefeuille of agencies, when the reality is this: there is an urgent need to find common sense and announcements in the field with practitioners!”.