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15. Jun '09 at 15:14

News from France on quality assurance in general practice

April 2006

Professeur Marianne Samuelson
Professeur Associé de Médecine Générale,
Directrice du département de Médecine générale,
Faculté de Médecine de Caen,
CNGE (Collège national des généralistes enseignants)

Professeur Hector Falcoff
Professeur Associé de Médecine Générale,
Faculté de Médecine Paris 5 René Descartes, Paris,
Coordinateur du Département Recherche de la Société de Formation Thérapeutique du Généraliste (SFTG)

Last June, we wondered whether effective and relevant political decisions would be made. As often, the answer is mitigated. Two important laws were voted in August by the Parliament, bringing about some changes in the organisation and funding of French Healthcare system.

The health insurance system is becoming more and more complex

Patients have to choose a “treating doctor” witch has to refer them to others specialists if they want to get refunded. This doctor might not necessarily be a GP, but might be a specialist in case of chronicle disease.  This can be interpreted as an introduction of some kind of gate keeping, but with no patient list. Patients can change “treating doctor” anytime they want, no changing in the payments system for doctor that means no capitation. In fact there is no recognition of the central role of a primary care doctor in the system.

  • A very confusing funding system that might open big opportunities to private insurers for wealthy people and might bring difficulties for lower middle class people and some elderly.
     
  • A co-payment of One Euro per contact with a doctor, even in primary care.
     
  • A centralised and computerised medical file for every patient is also planned, but up to now no money has been put on the table, and it is not sure that the project is feasible.

 

Creation of a High Authority in Health Care (“Haute Autorité de Santé” – HAS) replacing ANAES
This body in now not directly linked to the Health Care minister but chaired but a group of eight prominent persons designated by different major political bodies.

This new body’s mission will be to give independent advice to policy makers, professionals and patients about the quality of health services, and provide information as to products and services that should be paid by health insurance systems.

Mandatory practice assessment for all doctors
Some kind of practice assessment and quality improvement activities is now mandatory for every doctor working either in hospitals or ambulatory care.

The responsibility for assessment of procedures of quality improvement methods is also devoted to the “High Authority in Healthcare”. It is too early to say what these procedures will be, and to what extent the professionals will be associated to the process.

General Practice recognised as a full academic speciality
Vocational training last six semesters and is under the responsibility  of the University The last semester can be spent by students as registrars, in well organised GP practices, but it is not mandatory.

This new process, where students work as registrars in a GP practice, seems very promising. Some practices may now organise as a real training facility,  where medical students still spend most of their practical training. The National College of teaching GPs (CNGE) is working hard to organise and make this new curriculum successful, as it is undoubtedly a significant improvement of the training of GPs in France.

The status of academic GP’s is still not the same as the specialist status in the University

- on French health statistics

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