Doctor cover is a postcode lottery

THE COVERAGE of GPs varies greatly across France with huge differences even between neighbouring departments, a study by the doctors’ professional body reveals.

The Conseil National de l’Ordre des Médecins (Cnom) produces an annual atlas on the spread of doctors in France but for the first time has also published figures per department.

Provence Alpes-Côte d’Azur (PACA) is the region with the most doctors per head (375 per 100,000). However, within it, the Alpes-de-Haute-Provence department counts just 274 doctors per 100,000 compared to 405 in the Alpes-Maritimes.

Ile-de-France has the widest disparities - 742 doctors per 100,000 in Paris (22% of France’s doctors), compared to 223 in Seine-en-Marne.

Dr Patrick Romestaing of Cnom said the studies were carried out to assist the new regional health authorities set up last month.

“When you look at regions with few doctors we see there are departments in even greater difficulty than the region as a whole. Also, within regions considered to have a lot of doctors, there are some departments with few.”

Cnom is concerned over “medical desert” areas.

Overall, 19 of the 22 regions saw a drop in doctors between 2008 and 2009 although France still counts an average of 290 doctors per 100,000 people, compared to 249 in the UK.

An added problem is age - half of doctors are over 50 and fewer medical students are taking up independent practice as GPs or specialists, opting instead to work in institutions like hospitals or as supply staff.

Dr Romestaing said: “In some departments only 4% of students are going into independent practice.”

He said there had been attempts at regional, departmental and local level to encourage doctors to set up as independents in less well-served areas, including linked study grants, schemes to build surgeries or even offer housing.

However it was not working, he said. Nonetheless, he said forcing doctors to work part-time in badly-served areas or face fines (an idea in last year’s healthcare reform law but not yet enforced) would only make things worse.

“It will create even less incentive to go into the sector,” he said.

Solutions included setting up multi-disciplinary clinics which were more attractive to the young than being isolated and helped cut paperwork,

The survey has been sent to the 26 new health authorities called agences régionales de santé - ARS. These replace a number of other regional or departmental-level agencies.

Dr Romestaing said it remained to be seen if they made things simpler: “Out of hours GP cover was organised at departmental level in partnership with us, now it will be done regionally by the ARS.”

The atlas can be seen at www. conseil-national.medecin.fr in the “Démographie” section.