Reforms to address France's 'medical deserts' pit doctors against nurses
The French Senate has passed a bill intended to address a lack of medical services that has divided nurses and private practice doctors, several thousand of whom protested in Paris this week.
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The legislation, first introduced in parliament by doctor and MP Stéphanie Rist, would allow healthcare professionals in France, including nurses, to perform medical acts without consulting a doctor.
Advanced practice nurses would be able to prescribe some medications on their own, and general practice nurses would be able to treat wounds and prescribe related exams and follow-up care.
Patients would also be able to go directly to specialists such as physical therapists or speech therapists without a referral.
Meanwhile pharmacists would be able to renew expired prescriptions for those with chronic illnesses up to three times, which would reduce their need to consult doctors, many of whom are overworked and can no longer take in new patients.
Private practice generalists are becoming increasingly rare in France, with some parts of the country considered "medical deserts" because there are so few doctors.
As a result, patients must travel long distances or go to the hospital for basic care. Six million French people – 600,000 of whom have a long-term illness – have no primary care physician, and public hospitals are already strained with budget cuts and increased demand for care.
Expanding healthcare beyond doctors
Nurses have welcomed the proposed legislation, which would expand their roles and allow them to increase patients' access to healthcare.
“It constitutes a first step towards the necessary reform of the healthcare system to benefit patients,” said the National Order of Nurses.
The legislation would reinforce the role of advanced practice nurses and support the evolution of the entire nursing profession, which is currently in crisis.
But doctors fear that broadening the role of other healthcare providers will undermine their work and put patients at risk.
Between 4,500 and 10,000 private practice doctors went on strike Tuesday and protested in front of the health ministry in Paris, organised by the collective Médecins pour demain (Doctors for tomorrow), with slogans like "No medicine without doctors".
The collective organised a strike in December to ask for an increase in the base rate for consultations, currently set at 25 euros.
Doctors push back
“If medical studies are so long, it’s not for nothing,” Anna, a doctor who was out protesting for the first time this week, told RFI.
Nurses “do not have the right skills to diagnose a patient globally, knowing all the pathologies and their consequences”.
Doctors say they would rather have more resources to do things like hire assistants, which would lighten their workload and make their profession more attractive to young people starting out, who are put off by the long hours and difficult conditions.
“I hear [doctors'] concern, and even sometimes their anger,” Health Minister Francois Braun said in an interview with the AFP news agency.
“But I also hear the anger of French people who are unable to find a doctor or receive the care they need.”
Legislation not a cure-all
The legislation passed in the National Assembly, France's lower house of parliament, in January. On Tuesday evening it was approved by the Senate, even if some senators had reservations.
“This bill puts forward piecemeal responses to a structural problem and will not resolve the serious problems our citizens are confronted with,” said Senator Corinne Imbert of the conservative Les Republicains, who nevertheless voted for the bill.
The text of the legislation must now be harmonised between the two houses of parliament, for a final vote in the National Assembly at the end of February.
Read also:
- Can health centres make up for the shortage of doctors in the Paris region?
- Fed-up French doctors and lab workers stage historic nationwide strike
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