At the end of April, the Minister of Health commissioned a team to generalize access to care services throughout France by the end of the year. The unions, which are calling for a strike in hospitals on Tuesday, see it as a way of “closing access to the emergency room”.
Regulate for better care. After the tensions that marred the emergencies during the summer of 2022, fears that they will recur in 2023 are increasingly felt, due to the lack of personnel. This is why the Minister of Health (PDF), François Braun, announced at the end of April his desire to limit the number of emergency room arrivals. To do this, it intends to generalize healthcare access services (SAS) to all departments by the end of 2023. Their objective: to regulate the flow of patients by encouraging them to contact the 15 rather than going straight to the hospital.
At the end of the line, medical regulation assistants (ARM) and doctors are responsible for directing patients to the most appropriate service: to the hospital in case of vital need or, if this is not the case, to a general practitioner, who reserves slots for unscheduled care. A regulation denounced by the unions, which call for strikes and rallies everywhere in France, Tuesday, June 20. “The minister intends to block access to the hospital, continue to close beds and attack the staff”thus denounces the CGT in its leaflet.
Increasingly requested emergencies
In 2021, more than 20 million people passed through emergency room doors, up from 18.8 million eight years earlier, according to the Ministry of Health. In question, the lack of practitioners and the aging of the population, which needs more care, leading to 6.7 million French people finding themselves without a doctor, according to Medicare. Added to this table is an emergency crisis, in 2019, where caregivers from more than 250 departments went on strike for six months.
It is therefore in this context that the SAS solution was put forward. Thus, in 2022, 22 territories were selected to test the system and since then, the idea has taken hold, since almost all the departments have implemented it or are in the process of experimenting, according to the ministry. of Health. In April 2023, only twelve departments were not yet concerned, according to this same source.
“The human and financial resources at the hospital are now constrained, we can no longer do as before”, warns Marc Noizet, at the head of Samu-Urgences de France since François Braun, former president of the union, arrived at the ministry. Both are great defenders of the device. It was the minister himself who led the flash mission on emergencies, published in July 2022, defending the regulation of these services.
“Very serious studies show that mortality increases in emergencies because patients are waiting in the corridors. This increase is explained because their arrival is not regulated.”
Marc Noizet, president of Samu-Emergencies of Franceat franceinfo
Hence the importance, according to the emergency doctor, of setting up airlocks to unclog the hospital. He cites as an example the Covid-19 crisis, during which “in many departments, the SAS have been experienced” without specific preparation. “This experience showed us that we had managed to maintain an emergency medical offer, while postponing the care that was not.he continues. It worked well.”
“The problem is the supply of care”
An enthusiasm that Christophe Prudhomme, spokesperson for the Association of Emergency Physicians of France (Amuf), himself a practitioner in Seine-Saint-Denis, does not share. “The concept may seem interesting at first glance, but the difficulty is the care offer”he underlines, while an experimentation of SAS is in progress in his service. “With the lack of medical personnel, we cannot refer patients to city doctors, watch the paramedic. And since doubt should always benefit the patient, when one of them calls, we send him to the emergency room.” It must be said that between 2010 and 2019, his department lost 190 liberal general practitioners and 60 hospital employees, according to the order of doctors. At the same time, the population has gained more than 92,000 inhabitants, according to INSEE.
Ultimately, “vsThis translates into a delay in care for patients, because they know our difficulties and are slow to call us”, summarizes the doctor. Self-censorship also noted by Gérard Allard, representative of users at the Nantes University Hospital, where the SAS have been gradually installed since 2019. “There has been a drop in emergency room attendance because people have held backhe observes. But we also collected testimonies from people who finally regretted not having gone to the emergency room when they thought they needed it, because, afterwards, they told us that their state of health had worsened.
A challenge of time and recruitment
The offer of care is not the only pitfall that the SAS will have to overcome to set up in France. Marc Noizet acknowledges that “to adapt the remaining 70 Samu, it will take time, resources and recruitment”. For his part, François Braun announced, in mid-May, a major recruitment campaign in medical regulation centers, with the opening of 700 training places. However, its effects will not be felt for at least a year, the learning time necessary to ARMs.
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“This campaign should have been launched last September, after the summer which was particularly difficult, in order to avoid repeating the same situation this summer”says Caroline Brémaud, head of emergencies in Laval (Mayenne). “Today, we do not have enough human resources to take so many calls”she points out. “For the SAS mode to be generalized, we would need 20 to 30% additional staff, and this level, we are not able to cross itadmits Marc Noizet. In any case, by the end of 2023, it’s mission impossible. It will be necessary to wait three, even four years, to climb to a mode of operation that is operational.”
Finally, for the regulation of arrivals at the hospital to be effective, the SAS will have to enter the minds of caregivers and patients. In Nantes, for example, Gérard Allard and Vincent Mevel, secretary general of the professional union CFDT Santé Pays de la Loire, regret the lack of coordination between city medicine and the hospital. “People have to learn to work together. Culturally, we inherit years and years of working in silos”, emphasizes Vincent Mevel. On the patient side, you will have to adopt a new reflex: dial 15 before heading to the hospital.