Health: lack of agreement, the unions of liberal doctors slam the door on Health Insurance

The doctors are reassembled to block. The six representative unions of liberal doctors (CSMF, MG France, Avenir Spé, UFML, FMF and SML) announced, this Thursday, January 19, to suspend the negotiation with the Health Insurance of their medical convention. This must set the rates for private doctors and their objectives in terms of access to care and public health for the next five years. If the talks, which began in November, are supposed to end by the end of February, the two camps are struggling to agree on several points.

First, they point to the limited room for maneuver of the National Health Insurance Fund (Cnam) because of a Social Security budget which, according to the unions, does not provide the means necessary to revalue the consultation rates. as they require. “It is the fault of the government which sticks us with an Ondam (National objective of health insurance expenditure) at 2.9%, well below inflation”, plague Jérôme Marty, president of the French Union for a free medicine (UFML). Some unions expect an increase in the price of the basic consultation, then an enhancement in the event of a complex consultation with an elderly patient or suffering from a chronic illness. And even when the doctor becomes the attending physician of a new patient.

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But the unions also regret that their dealings with the Cnam “are placed under the supervision of several legislative texts”. The bill of the deputy Stéphanie Rist “has thrown oil on the fire”, sighs Sophie Bauer, president of the Union of liberal doctors (SML). This text, adopted unanimously at first reading by the deputies of the National Assembly, opens access without medical prescription to certain nurses in advanced practice, masseurs-physiotherapists and speech therapists. It will be considered by the Senate on February 14.

Continuation of strike movements

However, many doctors fear losing their status as “pivot” or conductor in the patient care pathway. “Parliament votes on this text without any consultation with liberal doctors”, regrets Luc Duquesnel, head of the generalist section of the Confederation of French Medical Unions (CSMF). “There is no question of allowing direct access to IPAs, nor of granting them first prescription, protests Sophie Bauer. It is a profession that it was not necessary to create”. “We cannot allow them to prescribe drugs after 6 months of training in medical practice, whereas a medical student is authorized to prescribe after 7 and a half years!” Adds Jérôme Marty.

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As a reminder, the nursing diploma in advanced practice corresponds to a training period of two years, at a master’s level. The training program includes two months of internship in the first year and four months of internship in the second year.

Fearing “the end of jointism”, the doctors’ unions “demand that the negotiation not be done under duress” and demand “a favorable and strong signal from the government” to resume discussions. However, other bills tabled since last summer, both at the Palais Bourbon and at the Palais du Luxembourg, which aim to add constraints to doctors in terms of freedom of installation, will soon be examined by parliamentarians. “Health advisers at Matignon and at the Elysée have however told us that they think that these texts will worsen access to care”, breathes Luc Duquesnel.

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As a result, several unions are calling for the continuation or (re)launch of the outpatient staff strike as a protest against the government’s policy. If the members of the UFML have already ceased to take charge of the minor emergencies addressed by the medical regulation, those of the SML intend again to put away their coat and their stethoscope outside the opening hours of their offices. The CSMF has called on its members to join this strike “for an unlimited period” from Monday 23 January. Contacted, Health Insurance did not wish to react immediately.

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