- The Touraine law of 2016 and Ma Santé 2022 were to reorganize the health system with the creation of Professional Territorial Health Communities (CPTS).
- New structures that aim to better coordinate care between health professionals and the medico-social liberal on the scale of a territory.
- The rather slow start-up could be accelerated by the coronavirus crisis, which highlighted the importance of communication between these professionals, but also between city and hospital.
For decades, experts have regretted the lack of coordination between the various health professionals on the one hand, and the lack of communication between the city and the hospital on the other.
The Touraine law of 2016, then the announcement of Ma Santé 2022 in September 2018 by Emmanuel Macron, were supposed to undermine this French flaw. In particular by boosting the creation of professional territorial health communities (CPTS). A barbaric name for a little-known concept that could change the lives of patients. Who, for some, saw this during this coronavirus crisis, during which the relationship with health professionals in a given territory has probably never been so fundamental.
What is a CPTS?
This grouping of liberal health professionals (nurse, general practitioner, specialist, physiotherapist, pharmacist, but also medico-social professionals), between 100 and 1,000, initially allows these caregivers to assess the needs of a territory given in terms of care. Then, they set up communication tools and learn to organize themselves to create a real patient-centered care path. So that the attending physician is aware and advises when a diabetic patient needs to go to a podiatrist or receive nursing care at home, for example. Once the CPTS project has been finalized and validated by the Regional Health Agency, this structure (association or other) can receive long-term funding from the ARS and Social Security, in order to have a coordinator who organizes this CPTS. And that this new stratum does not nibble on too much medical time…
The government aimed to unclog hospitals, improve the flow and relevance of care. And for ambition to reach 2,000 CPTS by 2022. Which seems compromised. "There are 500 projects or achievements of CPTS, 40 of which signed the flat-rate agreement," emphasizes Claude Leicher, president of the National Federation of CPTS. In the space of two years, it's fast! But in fact, a study by the Velite cabinet released on Tuesday seems less optimistic. At the end of May, there would only be 129 “active” CPTS, that is to say which carry out many missions, and 261 in the pipeline. With a very unequal distribution: 20 CPTS seem to be in working order in Occitanie, against only 3 in Nouvelle-Aquitaine.
The coronavirus, a springboard for CPTS?
"In reality, this implementation varies from region to region and takes time," stresses Anaëlle Renou, consultant in charge of this study. But the Covid crisis has boosted the CPTS and shown their importance. This could generate a craze for liberal health professionals. For Claude Leicher, it is obvious, the crisis has underlined the interest of creating these professional groups. “In a CPTS where we had already implemented procedures, we know the players, we have the tools to communicate, the organization was done quickly and smoothly. An example to follow, then? "Where there were none, people understood what a CPTS is," he said.
"The number of CPTS passed from" in project "to" active "has increased significantly, adds the consultant. Liberal health professionals have found little involvement in the health response. They wanted to be useful. They chose the CPTS as leverage. Praised by healthcare professionals, this project has a future. Especially since it is an asset for professionals because it breaks the loneliness [including generalists, who are often carriers of the project], it increases the attractiveness of certain areas, including medical deserts. "
Having the address book of all the health professionals in its territory to reorganize the offices, inform the population, and appeal for donations was indeed a strength in this period.
Concretely, how did it translate?
“The CPTS have done a lot to help their patients,” continues the consultant. For example to create Covid centers to test, set up call centers, WhatsApp groups between caregivers, organize the recovery and redistribution of masks. They organized the response, via information among themselves or communication intended for the public (through their Facebook pages, for example) on their scale, which is interesting because it is as close as possible to the patients. "
Claude Leicher, president of the Federation of CPTS, but also a general practitioner in the retired Drôme, for example put on his blouse and quickly asked the colleagues of his CPTS to organize care in a particular context. “As of March 9, with generalists, nurses, pharmacists, we thought about the right strategy to protect fragile people. We organized separate flows for a Covid consultation and for the other patients, but also different schedules, we received the elderly in the morning. To encourage home care for dependent people, priority was given to personal assistance and household help was withdrawn. "
Still challenges
And Anaëlle Renou to sum up: "the Covid crisis was a baptism of fire for the CPTS". The period also highlighted certain difficulties. “We are in a period of maturation, admits Claude Leicher. The point that remains problematic is the communication between the CPTS and the hospital. We had a hard time having their blank plan, their hospital reports. This highlighted the need to formalize city and hospital coordination. "
Precisely, this doctor participates in the "Ségur de la santé", negotiations opened at the end of May, until mid-July, supposed to overhaul the entire health system. And tackle, in the multitude of subjects on the table, the famous link between city and hospital. "As part of the" Ségur ", we will insist on the need to better formalize a coordination cell between city and hospital. So that for example, when a patient is hospitalized, his attending physician systematically receives an email to warn him. In return, the doctor returns the medical summary section. It sounds simple, but the service rendered is considerable. Sometimes the patient is an elderly person who no longer has a family and who loses memory. "
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