Initiated by Macronist MP Stéphanie Rist, the text responds to one objective: to facilitate access to care by unblocking the offices of general practitioners, while six million people have no attending physician. Tuesday, May 9, he obtained a final green light from the Senate, before the vote of the Assembly expected at the end of the afternoon this Wednesday. Under certain conditions, the French will be able, without going through their treating doctors, to consult nurses in advanced practice – the “IPAs” who intervene in particular on certain chronic diseases. Introduced at the start of the 2018 academic year, the advanced practice nursing degree is awarded at the end of a two-year university course.
“At 1,700, we are not going to revolutionize the health system, but this gives us prospects for greater intervention by nurses in the fields of prevention, screening and health promotion”, argued Julie Devictor. , president of the IPA National Professional Council, on the specialized information site Infirmiers.com. It is therefore a question of improving the monitoring of chronic pathologies while freeing up medical time for doctors. Same thing for physiotherapists and speech therapists: these consultations would no longer require a mandatory passage through the doctor’s box to benefit from a prescription.
But the initial ambition of the bill, which provoked an outcry from doctors, has been partly reduced. The revised copy provides that, to go to IPAs and physiotherapists, direct access will be limited to those working in structures such as multi-professional health centers, in coordination with doctors. Contrary to what the deputies wanted, caregivers simply registered in the more flexible framework of the Professional Territorial Health Communities (CPTS), which cover around half of the population, will therefore be excluded from the system. The CPTS were created by the “Touraine” law to modernize our health system in 2016. And for speech therapists in CPTS, direct access will remain possible. On this subject, a standoff opposed senators and deputies. The discussions were “bitter and long” in a joint joint committee, according to Stéphanie Rist, before the parliamentarians gave up integrating into this law these nurses and physiotherapists exercising independently.
Nurses, podiatrists… Expanded skills
The text “will only have a cosmetic effect”, deplores Sébastien Guérard, the president of the French Federation of physiotherapists and re-educators (FFMKR), who estimates that only 3% of physiotherapists work in nursing homes. Direct access to these physiotherapists will be possible for eight sessions, instead of the ten in the text voted on at first reading in the Assembly. The deputies however snatched an experiment in six departments including two Overseas, she underlines. “One of the keys to the success of physiotherapy rehabilitation is the early treatment”, said Wednesday morning, the president of the National Union of Masseur-physiotherapists, Guillaume Rall. In other words, a circuit breaker that would allow patients to be taken care of more quickly.
As for general care nurses, article 1 of the “Rist” law authorizes them to take charge of “the prevention and treatment of wounds including the prescription of additional examinations and health products” in coordinated and conditioned exercise by following a “training dedicated to wounds and healing”. Always with the aim of facilitating the journey of patients, the text expands the skills of podiatrists-podiatrists and orthoprosthetists. The latter will now be able to adapt “initial medical prescriptions for plantar orthotics less than three years old”. Another example: opticians-eyewear manufacturers are authorized to adapt a prescription for corrective lenses or contact lenses with the written consent of the ophthalmologist.
In addition, the text arouses great enthusiasm among pharmacists, whose role will be increased, in particular to renew a prescription in the event of a chronic condition and to administer vaccines. The provision makes it possible to avoid an interruption of treatment when a prescription expires while the patient is without an attending physician. A last-minute amendment will permanently authorize biologist pharmacists, in laboratories, to perform cervical smears in the context of cancer screening. Also, rapid tests for certain conditions – such as those for bacterial angina or cystitis – will be able to become widespread.
Overall, in the eyes of UFC-Que Choisir, even if “we must not have too many illusions about the immediate impact” of this law for patients, “a dike has been broken in terms of sharing of skills between the doctor” and other caregivers. As the senators argued, the parliamentarians of the joint joint committee rejected the doctors’ request for “territorial commitment”, which could have led some to take on more patients, do on-call duty or practice in a medical desert, for example. The deputy Horizons Frédéric Valletoux should bring a text in June before the Assembly, with the support of Renaissance, in favor of a reinforced “territorial commitment”. But it is insufficient in the eyes of the socialist Guillaume Garot who is carrying out cross-partisan work on the issue. This MP would like to point liberal doctors and dental surgeons towards medical deserts in a more restrictive way.