The Senate is considering access to care this Tuesday, under the supervision of doctors

Medical desertification, permanence of care... The Senate is examining from Tuesday a sensitive text on access to care, debates scrutinized with concern by the unions of liberal doctors who fear a coercive law. The timetable is not insignificant: liberal doctors are just coming out of a strike, suspended last week after the government launched new negotiations on a price increase.

Will Parliament require caregivers in private clinics to work nights or weekends at public hospitals? Will the freedom of establishment of practitioners be reformed to fight against medical deserts? So many questions that the bill from MP Frédéric Valletoux (Horizons) attempts to answer. The National Assembly adopted it in mid-June, it is the Senate's turn to consider it.

“This text is unwelcome, it crystallizes criticism from health professionals at a time of conventional negotiations and examination of the Social Security financing bill” in the Assembly, squeaks Corinne Imbert, designated rapporteur in the Senate. “The government is trying to push through with measures that irritate but solve nothing,” continues the senator attached to the Les Républicains group. The liberal doctors' unions have warned that they will monitor the evolution of this text, which aims to assign a form of territorial responsibility to practitioners, like milk on fire. It could lead to a “tough conflict” if it remained as it was, Franck Devulder, president of the CSMF union, one of the 12 organizations of liberal doctors at the origin of the strike, indicated in recent days. The Minister of Health Aurélien Rousseau promised to “get closer” to Frédéric Valletoux to “either better explain” the criticized articles, “or work on better writing,” the ministry was told.

One of the main points of tension concerns night or weekend hours, and an article aimed at allowing the directors of regional health agencies (ARS) to ask private establishments and their caregivers to provide them. A system that strongly displeases the unions of liberal doctors. Taken to task on this subject, the government has revised its copy and will propose an amendment aimed at clarifying this rebalancing between public and private: it wants this to be done primarily on the basis of “voluntariness”, with a designation of authority only “as a last resort” in the event of a lack of continuity of care.

The other reason for irritation concerns the freedom of installation of private doctors, which some would like to reform to condition the installation of a practitioner in areas already well provided with caregivers on the departure of another. One way to fight against medical desertification by “directing” medical facilities towards poorly provided areas. This transpartisan proposal had already caused a lot of discussion in the National Assembly but was rejected. It does not appear in the initial text but several senators who have taken up the torch will try to include it, particularly within the environmentalist, communist and socialist groups... and even in the centrist ranks.

Related rapporteur LR Corinne Imbert is nevertheless unfavorable, deeming the measure “counterproductive” and fearing “massive disruption” if Parliament adopted it. In the Social Affairs Committee, the Senate has already taken a step towards doctors' unions by removing their automatic membership in professional territorial health communities (CPTS), supposed to facilitate coordination at the territorial level.

The upper house is also preparing to adopt other measures in the text: such as experimenting with a health option at high schools in medical deserts to encourage vocations, or strengthening “physical and mental” support for medical students in their internships. Proof of the tension around the text, the Senate has planned four days for its examination, which could stretch until Friday... Before final adoption, senators and deputies will have to find a compromise during a committee mixed gender, the date of which remains to be defined.