In line with the 2018 health system transformation strategy, and along with the national emergency crisis, the “emergency redesign pact” announced in 2019 initiated the creation of a “care access system” (service d’accès aux soins (SAS) in French): a tool that aims to improve access to un-scheduled care  and the coordination of private healthcare professionals. Alcimed’s Innovation and Public Policy team deciphers the challenges and keys to success.
Care Access Service (ATS) Issues
While 43% of emergency visits could be taken care of in the city , two main findings have been brought to light on a national level:
- Patients go to the emergency room due to the lack of access to other alternatives
- The alternatives, when they exist (e.g., SOS Médecins, Doctolib, etc.) are insufficiently coordinated, exhaustive and comprehensive for patients
The « Care access service’s » challenge is to offer, thanks to a digital platform and a call center, a simple and alternative service to access a health professional quickly and remotely. This service is intended to be accessible 24/7 for every French person, regardless of where they live or their level of inclusion in the healthcare system.
To do so, the goal is to establish a territorial service and manage it in concert with the hospital’s staff of the SAMU’s (Emergency medical assistance service) department and the private healthcare professional’s that are part of the “professional territorial health community” (communautés professionnelles territoriales de santé (CPTS)) , in close cooperation with the rescue services.
Since November 2020, 22 pilot areas have been implementing the “care access service” as an experiment, covering 40% of the French population. Based on our experience with several of these areas, we wanted to highlight 3 key elements that must be taken into account by the “regional health agencies” (Agences regionales de santé – ARS) and all the stakeholders in view of the generalization of the “care access service” in January 2022.
Capitalize on the historical and operational unscheduled care providers
The “care access service” was created to rely on the care providers  already present in the territories concerned: multi-professional health centers, medical or paramedical centers, centers specialized in unscheduled care, etc. It is therefore necessary to capitalize on the current offers by mapping them out at the start of the project with the support of the “professional territorial health communities” and health professional groups when there are no communities on the given territory.
Then, on the basis of this offer, the challenge is to define an initial organizational structure to respond to the requests of unscheduled care, taking into account the specific geographical characteristics of each territory.
Establish an integrated and coordinated organization with all the stakeholders of the territory
This step is fundamental in order to guarantee the engagement of professionals and a shared and harmonized project management by the actors involved in the “care access service”.
In particular, it is necessary to design an integrated organization between the “regional health agencies”, the health insurance and the “regional union of health professionals” (URPS), and especially with the regional union of private practitioners.
In order to make the organization legible for professionals, it is also necessary to put in place an ad hoc communication plan. Once again, the “professional territorial health community” (CPTS) can be the right intermediaries to carry out this communication with health professionals while limiting the number of requests, as can the “regional union of health professionals” (URPS).
Plan a realistic and phased deployment for the “care access service”
Finally, in the implementation of “care access center”, it is important to plan a realistic and phased deployment, especially concerning the mobilization of caregivers. Indeed, the identification of slots dedicated to unscheduled care on a regular basis, and the associated changes in compensation, imply organizational changes whose impact in terms of commitment and implication should not be underestimated.
In addition, advertising efforts about “care access service” to the general public have a significant impact on the number of incoming calls and therefore on the scale of the service.
The « care access service » is intended to be extended beyond the experimental territories in the course of 2022, and to be progressively generalized throughout the country. There is no doubt that the deployment of the “care access service” will profoundly change our reflexes in emergency situations, and that it will accompany a major transformation of primary care towards greater coordination between professionals. You’re an “regional health agency” (ARS) and you’re conducting an experiment? Or you are about to move towards the generalization of the “care access service”? Alcimed is here to support you !
 Unscheduled care responds to the needs of patients with a health problem that is not a life-threatening emergency but whose care cannot be anticipated or delayed.
 Source : the « Pacte de refondation des urgences », september 2019 (https://solidarites-sante.gouv.fr/IMG/pdf/_urgences_dp_septembre_2019.pdf).
 The “professional territorial health community” (communautés professionnelles territoriales de santé (CPTS)) bring together professionals from the same territory who wish to organize themselves – on their own behalf – around a health project to address common issues.
 Care providers are the facilities and health professionals who carry out care and consultations: MSPs, CPTSs, liberal professionals, etc.
About the author,
Agnès, Project Manager in Alcimed’s Public Health Policy team in France
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