the challenge of good patient referral

It was originally an idea of ​​the former head of the emergency department, general medicine, justice and precariousness of the Mercy hospital (Moselle) and current Minister of Health and Prevention, François Braun.

Adopted in 2019 by the Minister at the time, Agnès Buzyn, the healthcare access service (SAS) is a local telephone referral platform which aims to advise and connect patients with healthcare professionals, in in the event of an emergency, unscheduled care or when the attending physician is unavailable.

Volunteer doctors

In practice, the patient joins the SAS platform of his territory, where he is listened to and advised by a medical regulation assistant (AMR), responsible for estimating the degree of urgency. The patient is then redirected, either to the emergency services via 15, or to a doctor for an appointment within 24 to 48 hours.

Volunteer doctors, known as “effectors”, report to the SAS upstream and free up time slots for this unscheduled care. They are then remunerated annually on the basis of a flat rate depending on the number of slots they have opened per week.

The objective: to unclog emergency services, where 43% of patients could be cared for in a practice, a home or a health center. This device has been implemented on an experimental basis in 22 territories across 13 different regions since the summer of 2020, but some health professionals doubt the efforts put in place by the government to support such a measure.

A measure that “skates”

“The difficulty is that we lack regulators and effectors”, regrets Jérôme Marty, general practitioner and president of UFML-Syndicat.

“Not all means are implemented to make it work”, deplores Éric Blondet, neurosurgeon and president of the Regional Union of Health Professionals (URPS) of liberal doctors of Bourgogne-Franche-Comté. He welcomes “a good measure in itself”, but notes that “in certain territories, patients can reach 1,500 people and that it is already complicated to take care of your own patients”.

“There are regions where it works, others where it works less, simply because some areas are more densely populated than others, assures Jean-Christophe Calmes, general practitioner in Frontignan (Hérault) and president of the URPS of Occitania. In large cities, call centers are totally bottled up. »

He also points to a “problem of education” of the French in the face of health. “I recently examined a patient who had gone through 15 when she had a sore throat and 38 fever… People need to ask themselves the question of what is urgent and what is less so. »

In theory, Dr. Calmes underlines an interesting measure: “When it is well regulated at the SAS level, around 70% of medical procedures are avoided”, patients being advised directly over the telephone. “But there we receive too many calls, so we don’t have time to assess properly. »

Absence of evaluation on the test territories

On the eve of the expansion of the SAS, the two doctors point to the absence of an evaluation carried out on the test territories, contrary to the commitments of the executive. “If we want it to work, we have to do things correctly and in the right order! In short, to solidify and secure what is already in place, before extending the system to a larger scale,” launches Dr. Éric Blondet.

For its part, the Ministry of Health and Prevention ensures that it will continue “the feedback devoted to the SAS” and promises a “next finalization”.​​​​​​

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