French healthcare workers reject Macron’s plans to reform the system

Unions say the proposals do not go far enough and are calling for urgent improvements to patient-staff ratios

Hospital staff are calling for protests this spring against a reform plan they say does not offer real solutions
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Hospital staff have rejected new plans to reform the healthcare system and are calling for large-scale protests this spring.

We outline the key points of the measures proposed by President Emmanuel Macron earlier this month to tackle doctor shortages and deteriorating working conditions:

Hospital funding model to be reformed

His promise for hospitals to be run by a collaboration between administrative and medical staff was welcomed by healthcare workers.

As was the pledge to end the current T2A funding model, which allocates funds to hospitals based on productivity.

This has been accused of making hospitals chase after profitability and the treatments which bring the most funding, and of undervaluing long-term care.

“We need to change: T2A is not adapted to chronic illnesses,” said Dr Olivier Milleron, cardiologist and member of Collectif Inter-Hôpitaux, founded to protect public hospitals.

“But saying we are going to end T2A without saying what will replace it is a confusing, even shocking, message.”

He was speaking during a press conference organised by a number of different healthcare worker groups to call for urgent action and for a collective movement.

Dr Floriane Zeyons, cardiologist and part of Minute de silence, a movement of health workers observing a minute’s silence to denounce the state of public healthcare, said: “Despite certain commendable, long-term objectives, such as ending T2A, no concrete measures have been taken to immediately improve patient care.”

Read also: Am I assigned a doctor in France or do I need to register?

Help for chronic illness

The group particularly claims the plans do nothing to tackle staff shortages.

The government has already scrapped the numerus clausus, the limit on the number of medical students who can continue into their second year but President Macron admitted: “We are going to see, in the years to come, a situation which will get worse in terms of access to healthcare. We don’t train doctors in one or two years.”

The president promised the 600,000 people suffering from a chronic illness who do not have a GP they would have one, or a team of specialists, by the end of the year.

Read more: Lack of doctors in France ‘means rural residents are dying younger’

Hospital 35-hour work week too rigid

He also criticised the “ultra-rigidity” of the 35-hour week for hospital staff.

Health minister François Braun later clarified the 35-hour week would not be abolished but it would be made easier to claim overtime.

More money for out-of-hours doctors

President Macron also promised to better remunerate doctors who offer out-of-hours services and take on new patients.

“We can’t have, on one hand, doctors who wear themselves out beyond what is reasonable to be on duty at the weekend, to take a patient during lunch, to always do more and who feel responsible for the local population ... and say we will have the same approach with them as with doctors who say ‘I can’t take a single person more’.”

Unions say nursing profession is ‘under-staffed and under-paid’

This was not enough to convince health unions, which are calling for a drastic improvement to patient-staff ratios to make the profession more attractive.

Thierry Amouroux, spokesman for the SNPI nurses’ union, said: “The government says we have to close beds because there are 60,000 vacant nursing positions but 180,000 working-age nurses have left.

“We just need to convince a third to come back but they are not going to come back for deteriorating working conditions, patients being put in danger, and to be under-staffed and under-paid.”

Read also: Explainer: the CSS, France’s free or low cost top-up health insurance

No mention of doctors’ fee increase from Macron

Thousands of private GPs closed their offices and went on strike in December and January.

Read more: Why GPs in France are threatening to strike in December

Their demands included doubling the standard consultation fee from €25 to €50, most of which would be reimbursed for patients in the health system.

The measure did not feature in the president’s speech.

Doctors reported being overwhelmed by admin tasks and said the €50 fee could be used to fund extra staff to whom these could be delegated.

Read more: French GPs list seven ‘useless or insulting’ tasks they have to do

President Macron said more ‘medical assistants’ would be recruited to help with admin tasks.

The role of medical assistant was created in 2018. Currently 4,000, their number should rise to 10,000 by the end of 2024, a year earlier than previously planned.

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