Question 9964 — health

Summary

The constraint of medical demography is indeed very significant in Hauts de France, where the medical density amounts to 302 active doctors per 100,000 inhabitants as of January 1, 2018 (338 in the whole of France), with strong disparities between the departments (255 in Pas-de-Calais). Concerning general practitioners with liberal or mixed practice, the difference in density is however less marked (101 practitioners per 100,000 inhabitants for the region compared to 102 in the whole of France) but the situations remain very contrasting depending on the departments: this ratio is 93 in Pas-de-Calais, compared to 117 in the Somme or 114 in the North. Strengthening access to healthcare for the French is a priority for the Government, which launched the equal access to healthcare plan in October 2017, supplemented by the health system transformation strategy “Ma health 2022” presented by the President of the Republic on September 18, 2018. The method followed by the Government is based on a panel of solutions adaptable to each local context because the response to demographic difficulties is not unique. It is organized around the following priorities: -strengthening the provision of care in the territories serving patients, to ensure the presence of health professionals in the areas sub-dense, by facilitating their installation or exercise in these areas; -the implementation of the digital revolution in health to abolish distances, with in particular strong support for the development of telemedicine; -better organization of health professionals to ensure a long-term and continuous caring presence via, among other things, the development of coordinated exercise structures (health homes multi-professional, health centers) and the assurance of a response to requests for unscheduled general medicine consultations for patients. All forms of coordinated exercise will be encouraged depending on the territory: Primary Care Teams (ESP) bringing together general practitioners and other health professionals, or even Territorial Professional Health Communities (CPTS) bringing together more largely the health actors of a territory around a common project, are also part of the levers to be mobilized. The objective is to trust local stakeholders to build projects and innovate within the framework of territorial responsibility. This plan is also intended to be evolving and is intended to be enriched. The Minister of Solidarity and Health has designated three national plan delegates to attend the meeting local actors in order to identify successful initiatives in the territories and also the difficulties faced by health professionals.  Thanks to the conventional inter-professional agreement signed in 2017, which perpetuates and strengthens collective remuneration for teamwork, the amounts of financial support paid to multi-professional health centers (MSP), up 96.7% compared to last year, amount in total to 35.6 million euros. In Hauts-de-France, the number of MSPs increased fourfold between 2010 and 2017. Several emblematic MSPs such as those of Laventie or Fruges in Picardie combine large and dynamic multi-professional teams, a solid territorial partnership as well as multiple innovative projects. The conditions for rapid deployment of telemedicine are in place, to allow patients to obtain, particularly in areas under tension, faster support and monitoring. Teleconsultation has been reimbursed since September 15, 2018 throughout the country and for all patients. For tele-expertise, this will be possible from January 2019 in areas in tension, before generalization in 2020. Particularly promising projects have already been implemented. In Hauts de France, the agency regional health authority is particularly involved in this area: it financially supports several experiments: tele-expertise for the detection of skin tumors in Aisne, Oise and Somme (thanks to this system, 91 general practitioners can request remote expertise from fellow dermatologists) or even tele-expertise for the management of chronic or complex wounds in South Avesnois, between three MSPs and the Sambre-Avesnois hospital center. The texts relating to the training and practice conditions of nurses in advanced practices have been published: around ten universities offer master's level training (since the start of the 2018 school year). Several hundred advanced practice nurses will be deployed to the field in the next two to three years. This measure will make it possible to strengthen the structures of coordinated exercise in primary care and free up medical time. The upcoming renewal by the regional health agency of the zoning to identify under-dense areas or areas presenting difficulties in accessing medical care is part of the same dynamic aimed at monitoring as closely as possible the evolution of the offer in this territory.

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