Health Minister and former hospital doctor Agnès Buzyn will also end the controversial numerus clausus, a convention which limits the number of second-year students wanting to be doctors, midwives, dentists or pharmacists.
In all, there are 54 measures attracting €400million of new funding. The Elysée said it was a “systematic overhaul” hastened by severe problems in areas such as casualty, psychiatry and medical studies.
President Macron said there would be “no economies hitting hospitals in my term.”
Ms Buzyn said the ‘Ma Santé 2022’ plan had a €3.4billion budget over that period – €1.6bn to revamp regional care, €920m for hospital investment, €500m for digital upgrades and €420m for training.
That is 2.5% extra spending a year and the ministry will create “room to move” by cutting “useless” procedures that add up to €20bn.
Leading GP union MG France hailed the plan for assistants, with president Jacques Battistoni calling it “good sense”.
He said they had long sought it to “make it easier to cope with lower doctor numbers by allowing GPs to devote to the main tasks; but it needs funding.”
The CSMF union said it was a “long-awaited step forward” adding that “ending the priority for hospitals was much needed”.
One key change for the future is a new selection process from 2020. It will open medicine to people with profiles away from the classic maths/science and also let students switch courses.
Of more immediate effect is the creation of 400 salaried doctors to work through local hospitals or health centres in areas with few health professionals to hasten access to healthcare.
It matches doctors’ wishes as two-thirds of new doctors say they would prefer to be salaried rather than médecin libérale. A similar plan in Saône-et-Loire saw 30 doctors hired on 35-hour-a-week contracts to ease delays.
Doctors and health centres will be helped by 4,000 assistants – a job between nurse and medical secretary – to prepare people for consultations by taking blood or other tests etc. Used in emergency centres they free 25% of a doctor’s time.
They will work with GPs or specialists and may work with several doctors or as job-share to cut the €50,000 annual cost.
Mr Macron wants doctors to create joint practices and no longer have half of doctors working alone. This would allow a spread of shared services such as out-of-hours garde services in evenings.
Doctors will not be coerced into change but will get heavy incentives to help cut the load that falls on emergency units.
A new hospital funding method is being created to end the tarification à l’activité based on numbers of procedures and not effectiveness or patients’ views.
Creating more standard tariffs, it will start with treatments for chronic illnesses like diabetes or renal failure.
It will also recognise quality care with extra funding and push hospitals towards working with neighbours to share skills.
Three categories of hospitals will give ‘local general, specialised and very specialised care’ and while none will close, the 600 smallest will be reoriented to priority needs such as geriatric, rehabilitation, telemedicine or scanning.