{"id":4723,"date":"2024-02-29T13:36:00","date_gmt":"2024-02-29T06:36:00","guid":{"rendered":"https:\/\/www.eurogroupconsulting.com\/?p=4723"},"modified":"2026-01-15T12:29:56","modified_gmt":"2026-01-15T11:29:56","slug":"permanence-des-soins-a-transformation-to-improve-access-to-care","status":"publish","type":"post","link":"https:\/\/www.eurogroupconsulting.com\/en\/publications\/article\/permanence-des-soins-une-transformation-pour-ameliorer-lacces-aux-soins","title":{"rendered":"Permanence des soins, a transformation to improve access to care"},"content":{"rendered":"<div data-elementor-type=\"wp-post\" data-elementor-id=\"4723\" class=\"elementor elementor-4723\" data-elementor-post-type=\"post\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5bebac3 e-con-full e-flex e-con e-parent\" data-id=\"5bebac3\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7402bd1 elementor-widget elementor-widget-text-editor\" data-id=\"7402bd1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>In a context where medical demographics are very fragile and even precarious, public health establishments are facing a real headache.\u00a0<strong>How can we ensure a continuity of care that meets the needs of the population while optimizing medical time and better meeting the requirements of quality of life in the workplace for caregivers?<\/strong>\u00a0This is the dilemma addressed by the recently proposed law\u00a0<a href=\"https:\/\/www.senat.fr\/dossier-legislatif\/ppl22-747.html\" target=\"_blank\" rel=\"nofollow noopener noreferrer\"><strong>\u00abImproving access to care through the territorial commitment of professionals\u00bb.\u00bb<\/strong><\/a>, promulgated on December 27, is an attempt to respond. The aim is to give regional health agencies greater flexibility to\u00a0<strong>organize local health structures and rebalance the medical forces present.<\/strong>\u00a0To succeed in this major restructuring, however, they need to take into account a number of unavoidable imperatives. An overview\u00a0<strong>the challenges and conditions for success of this necessary transformation\u00a0<\/strong>of our healthcare system.<\/p>\n<p>\u00a0<\/p>\n<h3 style=\"padding: 0px; margin: 0px; clear: both; color: #161616; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 28px; line-height: 34px; font-family: Montserrat, Helvetica, Arial, Verdana, sans-serif; letter-spacing: normal;\">Permanence of care: an essential public service mission to meet local needs<\/h3>\n<hr size=\"2\" width=\"100%\" \/>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<p><strong><br \/>Permanence des soins (PDS) is a public service mission, designed to meet the need for unscheduled health care outside normal opening hours.\u00a0<\/strong>It differs from continuity of care, which is a regulatory obligation for all care units to ensure the care of patients already hospitalized (over the same periods). Continuity of care is organized and divided between the public and private sectors:<\/p>\n<\/div>\n<\/div>\n<div class=\"standard-arrow list-divider bullet-top\">\n<ul>\n<li>In the private sector, through the organization of permanent outpatient care (PDSA)<\/li>\n<li>In emergency departments (EDs)<\/li>\n<li>In healthcare establishments, through the permanent care service (PDSES)<\/li>\n<\/ul>\n<\/div>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<p><br \/>To strengthen the balance and overall efficiency of the healthcare system, a host of initiatives have emerged alongside the SDP, including\u00a0<strong>Service d'Acc\u00e8s aux Soins (SAS), recently rolled out nationwide<\/strong>. The aim of this new service is to guide people through their healthcare pathway and enable them to access a healthcare professional at any time, whether in the public or private sector.<\/p>\n<p>\u00a0<\/p>\n<\/div>\n<\/div>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<h4><strong>Local organization struggles to find the right scale<\/strong><\/h4>\n<\/div>\n<\/div>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<p><br \/>To manage the care that falls within its scope, the PDSES must mobilize healthcare resources and technical platforms on a regional scale. Local coverage is necessary to meet the need for local service and limit lost opportunities. As a result, a large number of hospitals with emergency services and technical platforms now have an extensive PDSES in a large number of specialties, sometimes in the same region.<\/p>\n<p>However, given the constraints imposed by the population's growing need for medical care and the shortage of medical resources, the organization of the PDSES needs to evolve to reach its full potential.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7fca7baa e-con-full e-flex e-con e-parent\" data-id=\"7fca7baa\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-51a83577 elementor-widget elementor-widget-text-editor\" data-id=\"51a83577\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h3 style=\"padding: 0px; margin: 0px; clear: both; color: #161616; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 28px; line-height: 34px; font-family: Montserrat, Helvetica, Arial, Verdana, sans-serif; letter-spacing: normal;\">There are many reasons for poor performance<\/h3><hr size=\"2\" width=\"100%\" \/><div class=\"wpb_text_column wpb_content_element\"><div class=\"wpb_wrapper\"><p><strong style=\"font-size: 16px;\"><br \/>The PDSES, evolving in a \u00abdisparate\u00bb and fragile environment<\/strong><\/p><div class=\"standard-arrow list-divider bullet-top\"><ul><li>Growing demographic pressure<\/li><li>Unpleasant working conditions with repeated on-call duty and on-call duty in the face of a hospital medical demography under pressure<\/li><li>Healthcare professionals' higher expectations in terms of quality of life at work<\/li><li>Fragile healthcare organizations<\/li><li>Heterogeneity of regional PDSES deployment methods<\/li><li>Imbalance in contributions between public and private sectors<\/li><\/ul><p>\u00a0<\/p><\/div><div class=\"wpb_text_column wpb_content_element\"><div class=\"wpb_wrapper\"><h4><strong>The imbalance between public and private is widening<\/strong><\/h4><\/div><\/div><div class=\"wpb_text_column wpb_content_element\"><div class=\"wpb_wrapper\"><p><br \/>In 2023, the Minister of Health and Prevention referred to the\u2019<a href=\"https:\/\/igas.gouv.fr\/\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">inspection g\u00e9n\u00e9rale des affaires sociales<\/a>\u00a0(IGAS) to carry out a mission on the functioning of the PDSES and the challenges to be met in order to maintain this system over the long term. The surveys carried out as part of this mission highlight the role of public establishments, which provide 82% of on-call duty and 77% of on-call duty.<\/p><p>In fact, the PDSES is the \u00abdead weight\u00bb of public teams. They have to cope with this burden, which has a significant impact on their quality of working life. It takes 5 full-time doctors to ensure a sustainable level of on-call care for the teams. On average, however, the medical teams at small and medium-sized general hospitals are made up of 2 to 3 practitioners per specialty discipline.<\/p><p>Existing organizations, which rely on a limited number of practitioners, maintain the PDSES's dependence on external resources and additional financial rewards, at a time when the budgetary and financial context is particularly tense.<\/p><p>\u00a0<\/p><h3 style=\"padding: 0px; margin: 0px; clear: both; color: #161616; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-variant-position: normal; font-variant-emoji: normal; font-stretch: normal; font-size: 28px; line-height: 34px; font-family: Montserrat, Helvetica, Arial, Verdana, sans-serif; letter-spacing: normal;\">An in-depth overhaul of this flagship scheme is urgently needed<\/h3><hr size=\"2\" width=\"100%\" \/><div class=\"wpb_text_column wpb_content_element\"><div class=\"wpb_wrapper\"><div class=\"wpb_text_column wpb_content_element\"><div class=\"wpb_wrapper\"><p><br \/>In light of these findings, on December 18 the Senate passed a bill aimed at\u00a0<a href=\"https:\/\/www.senat.fr\/travaux-parlementaires\/textes-legislatifs\/la-loi-en-clair\/proposition-de-loi-visant-a-ameliorer-lacces-aux-soins-par-lengagement-territorial-des-professionnels.html#:~:text=Lundi%2018%20d%C3%A9cembre%202023%2C%20le,le%20mercredi%2027%20d%C3%A9cembre%202023.\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">Improving access to care through the territorial commitment of professionals.<\/a><\/p><\/div><\/div><div class=\"standard-arrow list-divider bullet-top\"><ul><li>A new regional PDSES organization scheme for greater consistency and fairness<\/li><\/ul><\/div><div class=\"wpb_text_column wpb_content_element\"><div class=\"wpb_wrapper\"><p><br \/>Given the difficulties experienced in recent years,\u00a0<strong style=\"color: #00b7ef;\">ARS must take full ownership of the issue, and redesign the regional scheme for organizing and operating the PDSES.<\/strong>. It will be based on 3 structuring pillars:<\/p><\/div><\/div><div class=\"standard-arrow list-divider bullet-top\"><ul><li>A better\u00a0<strong>taking into account the needs of each region<\/strong><\/li><li>A\u00a0<strong>better assessment of the medical forces involved<\/strong><\/li><li>All healthcare professionals need to understand that a \u00ab\u00a0<strong>collective responsibility\u00a0<\/strong>\"<\/li><\/ul><\/div><div class=\"wpb_text_column wpb_content_element\"><div class=\"wpb_wrapper\"><p><br \/>So, by distributing the effort between all the structures and doctors in a given region, the government's ambition is above all to restore a better organizational, medical and financial balance between public and private establishments.<\/p><p>The aim is also to standardize the way PDSES is implemented in the regions, while preserving a degree of flexibility to take account of certain local specificities.<\/p><p><strong style=\"color: #00b7ef;\">However, the restructuring of such a system to improve our healthcare system can only succeed if several key guidelines are observed.\u00a0<\/strong>There are five of them:<\/p><\/div><\/div><div class=\"standard-arrow list-divider bullet-top\"><ul><li>First of all, share on-call and on-call duty lines between a number of public or private structures in a given region, in order to\u00a0<strong>strengthen solidarity<\/strong>\u00a0in situations of medical shortage<\/li><li>Provide a response and organization adapted to the needs expressed within each structure<\/li><li>Efforts will need to be focused on pooling certain skills and profiles to serve the PDSES, regardless of the structure to which the healthcare professional is attached.<\/li><li>The new regional plan should ensure a better match between the financial dimension and the reality of the missions performed: stability and equity between on-call and on-call duty, system sustainability, etc.<\/li><li>Last but not least, the success of this overhaul will not be possible without taking into account the human side of the operation. It will therefore be necessary to find ways of better recognizing and supporting practitioners who work at night, as well as on weekends and public holidays.<\/li><\/ul><\/div><div class=\"wpb_text_column wpb_content_element\"><div class=\"wpb_wrapper\"><p><strong><br \/>It remains to be seen whether such ambitions will be operational in a context marked by severe pressure on medical demographics.<\/strong><\/p><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Dans un contexte o\u00f9 la d\u00e9mographie m\u00e9dicale est tr\u00e8s fragile voire pr\u00e9caire, les \u00e9tablissements publics de sant\u00e9 font face \u00e0 un vrai casse-t\u00eate.\u00a0Comment assurer une permanence des soins qui r\u00e9ponde aux besoins de la population tout en optimisant le temps m\u00e9dical et en r\u00e9pondant mieux aux exigences de qualit\u00e9 de vie au travail des soignants ?\u00a0<\/p>","protected":false},"author":1,"featured_media":4733,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[32],"tags":[],"class_list":["post-4723","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-article"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Permanence des soins, une transformation pour am\u00e9liorer l\u2019acc\u00e8s aux soins - Eurogroup Consulting<\/title>\n<meta name=\"description\" content=\"Retrouvez notre dernier article : permanence des soins, une transformation pour am\u00e9liorer l\u2019acc\u00e8s aux soins\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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