Science

GPs: Should some of their activities be outsourced to other caregivers?

Yes / Patient Problem Solving

Dr. François Arnault, President of the Order of Physicians.

We are at a critical juncture in organizing care in the area and are trying to find a solution to the shortage of doctors, in particular for the 650,000 patients with chronic diseases who do not have a general practitioner. Access to medical care is also a matter of ethics, which is why the National Council of the Order of Physicians raised this issue in a joint discussion with the orders of other medical professions (physiotherapists, pharmacists, nurses…).

Let’s be clear, this is not about bypassing the doctor, indispensable in his skills and the only one in the possibility of making a diagnosis. The goal is for patients to have access to a doctor everywhere. But when patients encounter difficulties in the field, the solution comes from closer collaboration between all health professionals, coordinated by the attending physician. In this context, and to free up medical time, the doctor can delegate certain actions to them. Thus, a well-informed pharmacist can prescribe short-term treatments for seemingly innocuous conditions.

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The order also decided in favor of the orientation delegation. If a general practitioner is not available, the patient should be able to contact another caregiver who will help them find medical care as quickly as possible. Under some acts, patients may already have direct access to these healthcare providers without first going through a primary care physician, as required by law. For example, to a physiotherapist for sprains or back pain for less than six months.

On the other hand, all these innovations cannot see the light of the day without re-evaluating the profession of general practitioner, because at the heart of the current difficulties lies the question of its attractiveness.

No / “Our profession is more than a series of actions”

Dr. Agnès Gianotti, president of the MG France union.

The number of general practitioners per inhabitant in France is higher than in most neighboring countries, and yet we are overwhelmed. What is the reason for this apparent paradox? Number of medical staff: here 0.3 per doctor, compared to 2.3, for example, in Germany. We have too few secretaries, paramedics for administrative tasks, and nurses for therapeutic patient education (smoking cessation, support for diabetic or overweight patients to help them change their lifestyle, etc.).

But today, when general practitioners should be allowed to have employees, we suggest that they make other medical professionals (nurses, as well as pharmacists, physiotherapists, etc.) responsible for accompanying patients who could not find a doctor. To wish to entrust them with part of our activity means to misunderstand its specifics: our profession is not a series of actions that we could cut and redistribute, the attending physician is responsible for the general care, in continuity, about the health of his patients. Imagine a patient addicted to opioid analgesics that I could wean. What happens if he goes to a pharmacist with a severe toothache who can prescribe painkillers? Without a medical card, he would risk offering him an opiate…

Where there are no general practitioners anymore, do we want nurses or pharmacists to refer a patient to a neurologist as soon as he has a headache? We don’t question the skills of other caregivers we need. But defending ours is not corporatism. Instead, let’s see together how best to proceed, instead of trying to impose solutions that will disrupt the care of our patients.

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