François Braun’s plan for the follow-up of the chronically ill

Will this be enough to help the many chronically ill people who cannot find attending physicians? “I can’t get the prescriptions to renew my treatment, so I buy it on the Internet”, testifies Sébastien (1). Like nearly one in three French people, he suffers from high blood pressure. Since he moved to Challans (Vendée) two years ago, he has not found a doctor and has had difficulty renewing his treatment. “All the surgeries around are full, so I stopped looking,” admits the father of the family.

Like him, 714,000 chronically ill people find themselves without a doctor. A situation against which the Minister of Health announces a plan of unprecedented magnitude. “The chronically ill are more and more numerous, and this figure will only increase, justifies François Braun. Apart from the vaccination strategy against Covid-19, the launch of this plan constitutes the largest “going-towards” operation that has taken place. It will allow us to solicit patients who are far from our health system. The health insurance funds will be at the center of the patient-doctor linking system designed by the ministry.

This effort will be done in stages, starting this March. First of all, at the level of each territory, the CPAM will send a letter to all patients with long-term illness (ALD) without follow-up in order to help them find a doctor. Then, the CPAMs will address generalists. Those who see a chronic patient three times a year for whom they are not the treating doctor will be offered to follow them, with an advantage, since a treating doctor receives – in addition to the price of the consultations – 70 € per year for each patient ALD for over 80s and €42 for those under 80.

The goal ? Reach one-third of chronically ill patients without an attending physician who nevertheless see a practitioner regularly. The workload of doctors will also be taken into account. “Physicians are already devoted to their patients. Our collective challenge is not so much to work more than to support doctors with new tools and new organizations to enable them to take care of more patients”, specifies François Braun.

Among general practitioners who do not see regular chronic patients, those with a patient base of less than 1,020 patients will be approached first, followed by those who work with a medical assistant or a nurse. Once these letters have been sent, in June, the data will be sent to the professional territorial health communities (CPTS) – which bring together local health actors – and to the CPAMs, so that they can find a solution adapted to each patient.

Contacts will be made primarily by the CPTS, but the agents of the primary funds will also be able to take over if necessary, which would correspond to their expectations. “The agents of the primary funds are, in fact, very motivated by the fact of being able to carry out concrete work to help people”, argues the Minister. In all cases, patients will remain free to choose their doctor and the latter to refuse a new patient. “This plan is based on a free acceptance of the different parties,” admits the minister’s office.

Also, after a first meeting with a practitioner, the patient may refuse to join the patient of the latter, and vice versa. “It is not a question of making administrative matching”, insists the ministry. Among the ALD patients without follow-up, some fear, in fact, to be put in contact with a doctor several kilometers from their home. In the territories which lack the most practitioners, “mobility aid could then be put in place”, specifies the cabinet of the ministry.

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