Why GPs in France are on strike and will doctor ‘no-shows’ be charged?

Independent GPs are once again on strike in France today (February 14), calling for rising consultation fees, and in opposition to reforms being debated in the Senate.

Why are they striking?

The main reason is to call for a higher consultation fee, to help free up GPs’ time by hiring administrative staff. They are also opposed to the Rist law (loi Rist), which is being debated by the Senate this week.

It comes after negotiations with the Assurance maladie broke down after two weeks of talks. The profession said in particular that the offer to raise the consultation fee from €25 to €26.50 only was a “provocation”.

GPs – including from the collective Médecins pour Demain – have instead been calling for the fee to double from €25 to €50, to help pay for better upkeep of surgeries and to hire administrative staff that could give doctors back hours of consultation time per week.

Even the major organisations of MG France and CSMF are asking for new fees that will be at least €30 per appointment. The European average is €46, the collective said (although the different types of reimbursement make direct comparison difficult).

“It’s ridiculous, even contemptuous,” said Dr Gabrielle Gallet-Voisin, GP in Loir-et-Cher, and spokesperson for Médecins pour Demain. “This is the first suggested rise in seven years, and it’s not even as much as inflation.”

The collective has 17,000 members on Facebook and has been coordinating the strike action. It says it is not affiliated with any particular union or political party, although most medical unions have shown support for the movement.

Dr Gallet-Voisin said that it was “mission impossible” to run a medical surgery with a consultation fee of €25 or €26.50. The collective has called for the government to “give back independent doctors the resources to meet the challenge” of the task.

They are calling for “extra financial support” to “improve accessibility for all people in France”.

Dr Pierre Bidaut, president of the l'Union régionale des professionnels de santé en Centre-Val de Loire (URPS), said: “We don’t even have the margin we need to hire more people.”

He said that it is “not acceptable” that six million people in France do not have a regular GP, due to a lack of time for consultations.

Read more: Why many doctors’ surgeries will be closed for a day in February

SOS Médecins join action

Staff from the at-home medical service SOS Médecins have also joined the action, calling for the “indispensable [need for] a reevaluation of at-home visits”.

They are stopping work for 24 hours until tomorrow morning.

Senate debates the Rist law

GPs have also timed the strike to coincide with the Senate debate on the ‘loi Rist (Rist law)’, which is taking place this week.

The law, named after its proposing MP Stéphanie Rist, Renaissance MP for Loiret, includes a suggestion to give direct access to physiotherapists and speech therapists without a doctor's prescription.

It would also allow advanced practice nurses (infirmiers en pratique avancée (IPA)) to make initial prescriptions. The idea would be to make access to care easier by reducing the number of compulsory visits to a GP. The Centre-Val de Loire region is set to operate a trial of the IPA system.

But some doctors say that this could compromise the quality of care being offered and mean some patients could be put at risk because they may skip seeing a GP (and therefore a possibly more serious problem could be missed).

Dr Bidaut said that GPs were not questioning the competency of IPAs. However, he said: “To take better care of patients, of course we need multi-professional practice, but these are procedures for which medical expertise is needed.”

He said that the two years of training done by IPAs was not enough (for all procedures) compared to the years of training completed by medical doctors.

Similarly, Dr Gallet-Voisin said that doctors need support with administrative work, not medical work. But she said: “If you think that renewing a prescription is just about a signature and a rubber stamp, you’re misconstruing a GP’s work.
“We need medical expertise to reevaluate the care. If it’s done badly, we risk delaying diagnoses.”

The Senate still needs to vote on the proposals, although it was unanimously passed by MPs in the Assemblée Nationale before heading to the upper chamber.

Read also: Minister calls for end to ‘useless medical certificates’ in France

Do all the GPs agree?

No. While most unions appear to be in support of the action, they do not all agree on the method, nor on the demands made.

Some have said that increasing the fee to €50 per consultation could mean some less well-off people would not be able to pay the remaining costs, and would therefore avoid visiting the doctor.

Patient organisation France Assos Santé said that the proposed fee is "unreasonable" for this reason. However, its president Dominique Beauchamp, said that she understands the difficulties doctors face.

She said: "It would be necessary for the remuneration to be more linked to the acts performed. Some consultations are worth more than €25, but others are surely worth less."

Dr Bidaut of the URPS said that he would be, in fact, in favour of a fee that changes depending on the complexity of the appointment or the patient’s needs.

What has the government response been?

So far, the government has not moved much from its position, and has responded diplomatically.

Health Minister François Braun has said that “his objective is to respond to the health needs of the population”, and that while he “understands the anger” of the GPs, he also understands that “of people in France who can’t find a doctor”.

Read also: Seven questions about ‘medical deserts’ in France

Will ‘no-shows’ to GP appointments be charged?

The Conseil national de l’ordre de médecins has said that in France, 27 million GP appointments are missed per year.

In response, Senators have suggested that GPs could be compensated for missed consultations, and that patients who fail to show up for no good reason would be subject to a financial penalty.

The Conseil said: “Each week, 6 to 10% of patients do not attend their appointments, which corresponds to a loss of consultation time of almost two hours per week for the doctor, whatever the discipline.”

Senators have suggested the charge could possibly come out of future reimbursements to the patient, as part of the loi Rist proposals. The law is still being debated in the hemicycle this week.

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