No-show fees, physios and pharmacists - France's plans to improve community healthcare
Amid an ongoing shortage of doctors and difficulty in securing appointments in many areas, French prime minister Gabriel Attal has announced a series of measures to improve community healthcare - including a €5 'no show fee' for people who don't turn up to appointments.
France has for years been suffering from a shortage of community-based healthcare staff, the problem is most acute for médecins généralistes (GPs or primary care physicians) but also affects dentists, community nurses and midwives.
The worst affected areas of the country are known as 'medical deserts', where it can be very difficult to get an appointment or to even register with a GP or family doctor.
READ ALSO What to do if you live in a medical desert
Over the weekend prime minister Gabriel Attal invited a group of regional journalists to a briefing where he laid out his plans to improve the situation. Here's what he said;
More doctors
The obvious solution to a shortage of doctors is to train more of them - and this is already happening since a cap on the number of places at medical schools was lifted after negotiations between the government and medical unions.
The number of trainee doctors has already risen from 8,150 in 2017 to 10,000 in 2023 and is set to rise further to 12,000 in 2025 and 16,000 in 2027.
But training doctors takes time, and in the meantime several other measures have been announced to help people get access to medical care.
From January, the number of medical assistants will also increase from 6,000 to 10,000 with the aim to taking some of the burden off GPs for routine tasks.
By June, the first incumbent of a new position should be in place - the 'emissary', whose job it is to help foreign doctors who want to come and work in France, or find French doctors who have moved abroad and who would like to return.
No-show fees
The main doctors' union says that 27 million appointments a year are wasted by people who book and then don't show up.
The idea has been discussed before, but Attal has proposed a €5 fee for anyone who gives less than 24 hours' notice to cancel an appointment. He wants to introduce the idea from January 1st 2025, although it will have to be discussed in parliament first.
The fee is colloquially known as a 'taxe lapin' since in French 'poser un lapin' means to stand someone up, or not to show up to appointment without explanation.
Attal also said that 15 bureaucratic procedures would be 'simplified' to allow doctors to spend less time completing paperwork, although he did not specify what the procedures are.
Expanding role of pharmacists
Pharmacists, who undergo seven years of training, can already give advice on a wide range of common medical problems, but their role is set to be expanded.
11 things you can do at a French pharmacy
As has previously been announced, pharmacists will be able to prescribe antibiotics for tonsillitis/strep throat and urinary tract infections. These measures have already been decided but the decree is not yet published, with Attal saying he was "putting pressure" to get the decree published and the service rolled out in pharmacies.
Opticians will also be able to give prescriptions for new glasses without involving a doctor.
Physio appointments
France has thousands of kinésithérapeutes (physiotherapists, commonly known simply as kiné) but in order to get appointment costs reimbursed you usually need to visit a GP first in order to get a prescription.
This summer a trial scheme will be rolled out in 13 départements (one in each mainland region of France) allowing people to go directly to the physio, rather than needing a doctor's appointment first. The trial locations have not yet been revealed.
Attal also mentioned expanding the 'direct access' programme to other specialists, but gave no further details.
Out of hours
The outpatient on-call system know as Système de permanence des soins ambulatoires (PDSA) which is in place when doctor's offices are closed (eg evenings, weekends and holidays) will in the autumn be extended to nurses, midwives and dentists.
The idea is to continue to offer non-emergency care even when your regular practitioner is not available - this is especially useful over the summer as many single-person services close down completely for a few weeks while the medic takes a well-earned break.
Expanded psychology services
In 2020 the French government launched Mon Soutien Psy (my psychology support) scheme offering up to eight free sessions with a psychologist.
However, very few practitioners have signed up to the scheme, saying the amount reimbursed is too low.
In the hope of encouraging more people to sign up, the government is expanding the reimbursement from €30 per session to €50 a session, as well as expanding the number of free sessions available from eight to 12. This is intended to be in place by June.
Palliative care
The government has also allocated an extra €1.1 billion for palliative care services.
This is in conjunction with plans to ease France's laws on assisted dying - some of the people who oppose the law change say that France's patchy provision of palliative care may drive people to end their own lives due to fear of inadequate care in their final days.
Attal said that health minister Catherine Vautrin will shortly make a detailed proposal for increased services.
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France has for years been suffering from a shortage of community-based healthcare staff, the problem is most acute for médecins généralistes (GPs or primary care physicians) but also affects dentists, community nurses and midwives.
The worst affected areas of the country are known as 'medical deserts', where it can be very difficult to get an appointment or to even register with a GP or family doctor.
READ ALSO What to do if you live in a medical desert
Over the weekend prime minister Gabriel Attal invited a group of regional journalists to a briefing where he laid out his plans to improve the situation. Here's what he said;
More doctors
The obvious solution to a shortage of doctors is to train more of them - and this is already happening since a cap on the number of places at medical schools was lifted after negotiations between the government and medical unions.
The number of trainee doctors has already risen from 8,150 in 2017 to 10,000 in 2023 and is set to rise further to 12,000 in 2025 and 16,000 in 2027.
But training doctors takes time, and in the meantime several other measures have been announced to help people get access to medical care.
From January, the number of medical assistants will also increase from 6,000 to 10,000 with the aim to taking some of the burden off GPs for routine tasks.
By June, the first incumbent of a new position should be in place - the 'emissary', whose job it is to help foreign doctors who want to come and work in France, or find French doctors who have moved abroad and who would like to return.
No-show fees
The main doctors' union says that 27 million appointments a year are wasted by people who book and then don't show up.
The idea has been discussed before, but Attal has proposed a €5 fee for anyone who gives less than 24 hours' notice to cancel an appointment. He wants to introduce the idea from January 1st 2025, although it will have to be discussed in parliament first.
The fee is colloquially known as a 'taxe lapin' since in French 'poser un lapin' means to stand someone up, or not to show up to appointment without explanation.
Attal also said that 15 bureaucratic procedures would be 'simplified' to allow doctors to spend less time completing paperwork, although he did not specify what the procedures are.
Expanding role of pharmacists
Pharmacists, who undergo seven years of training, can already give advice on a wide range of common medical problems, but their role is set to be expanded.
11 things you can do at a French pharmacy
As has previously been announced, pharmacists will be able to prescribe antibiotics for tonsillitis/strep throat and urinary tract infections. These measures have already been decided but the decree is not yet published, with Attal saying he was "putting pressure" to get the decree published and the service rolled out in pharmacies.
Opticians will also be able to give prescriptions for new glasses without involving a doctor.
Physio appointments
France has thousands of kinésithérapeutes (physiotherapists, commonly known simply as kiné) but in order to get appointment costs reimbursed you usually need to visit a GP first in order to get a prescription.
This summer a trial scheme will be rolled out in 13 départements (one in each mainland region of France) allowing people to go directly to the physio, rather than needing a doctor's appointment first. The trial locations have not yet been revealed.
Attal also mentioned expanding the 'direct access' programme to other specialists, but gave no further details.
Out of hours
The outpatient on-call system know as Système de permanence des soins ambulatoires (PDSA) which is in place when doctor's offices are closed (eg evenings, weekends and holidays) will in the autumn be extended to nurses, midwives and dentists.
The idea is to continue to offer non-emergency care even when your regular practitioner is not available - this is especially useful over the summer as many single-person services close down completely for a few weeks while the medic takes a well-earned break.
Expanded psychology services
In 2020 the French government launched Mon Soutien Psy (my psychology support) scheme offering up to eight free sessions with a psychologist.
However, very few practitioners have signed up to the scheme, saying the amount reimbursed is too low.
In the hope of encouraging more people to sign up, the government is expanding the reimbursement from €30 per session to €50 a session, as well as expanding the number of free sessions available from eight to 12. This is intended to be in place by June.
Palliative care
The government has also allocated an extra €1.1 billion for palliative care services.
This is in conjunction with plans to ease France's laws on assisted dying - some of the people who oppose the law change say that France's patchy provision of palliative care may drive people to end their own lives due to fear of inadequate care in their final days.
Attal said that health minister Catherine Vautrin will shortly make a detailed proposal for increased services.
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