"There won't be an agreement by tomorrow evening, that's almost certain, even if I still want to believe in common sense," Minister François Braun told France Inter on Monday.

The six representative doctors' unions have until Tuesday evening to say whether or not they accept the new fee schedule proposed for five years by Social Security.

It's "no" for the two main unions of liberal doctors, among general practitioners and specialists, they said on Sunday evening.

The National Health Insurance Fund (Cnam) provides that all medical consultations would be increased by 1.50 euros.

For general practitioners, this unconditional revaluation would bring the basic consultation to 26.50 euros, against 25 euros since 2017.

Practitioners agreeing to make "territorial commitments" (seeing more patients, participating in on-call duty, practicing in a medical desert, consulting on Saturdays, etc.) would obtain a higher consultation rate, at 30 euros for example for general practitioners.

Physicians are asked to subscribe to two of the commitments in this list.

"And when we say doing one call, it's one call per month, so let's stop saying it's an intolerable pressure," Braun said.

"It's not working more, it's working differently", in order to guarantee access to care for all French people.

With the rejection of the two organizations weighing more than 30% each among generalists and specialists, the draft agreement supported by the government is on the verge of falling through.

"We are missing out on an opportunity to improve the care of our fellow citizens, I find that the doctors' unions are not responsible", reacted François Braun, saying that he did not understand "such a closed position".

“We are going to waste time”

He recalled that the proposal represented an effort by the State of 1.5 billion euros, "more than what we have ever done in previous conventions".

"26.50 euros is not at all the value of the consultation. A doctor has more than 20% of his income which is made up of a lump sum, paid by health insurance, which makes a basic consultation at 36.50 euros”, he also recalled.

Among GPs, the question of the tariff was "marginal" in the outcome of the vote, assured Agnès Giannotti, the president of MG France, the largest union of GPs, explaining that practitioners suffer above all from a "lack of acknowledgement".

With a rejection of the agreement, the new tariffs will be set by an "arbitrator" - in this case, a senior official appointed by the executive - who will have "three months to propose a text (...) which will will impose for at least two years", specified the minister.

“We are going to waste time,” he lamented.

Some unions are now agitating the threat of a deconvention of many doctors, eager to regain their tariff freedom.

This "would penalize the French even more by creating a two-tier medicine, with only the rich who could be treated. This is not the spirit of Social Security", judged the Minister of Health.

He recalled that "the average remuneration of a general practitioner is 90,000 euros per year".

"We can consider that it is a fair remuneration, especially since with this agreement we will add 20,000 euros more per year," he said.

Still, the likely failure of negotiations between Social Security and practitioners will have concrete consequences for the approximately 6 million French people currently without a doctor.

For the 600,000 people with a chronic disease without a doctor, solutions will be found, promised François Braun, adding that he would make announcements "next week".

© 2023 AFP