The National Assembly voted unanimously, in first reading, a text on the “direct access” of patients to nurses in advanced practice (IPA), on the night of Wednesday 18 to Thursday 19 January. The objective of this bill brought by the deputy and rheumatologist Stéphanie Rist (Renaissance) is to improve access to care by freeing up time for doctors.
In concrete terms, this means that a patient will be able to directly consult an advanced practice nurse without going through their attending physician. These IPAs, practicing since 2018, are nurses at bac + 5 level qualified to monitor stabilized chronic pathologies, such as diabetes, but who also have orientation, prevention or screening missions. Faced with this possibility, GPs are concerned about the lack of training of APNs as well as the lack of communication that could occur.
Accompany and not replace the doctor
Today, general practitioners and IPAs already work together, in the same premises, in particular within homes or health centres. On the other hand, the first consultation of a patient is always with the general practitioner and not with the IPA. This direct access, Tatiana Henriot, former president of the National Union of Advanced Practice Nurses, has been asking for it for several years: “For the patient care pathway, it makes sense. Today, many patients do not have an attending physician. Rather than going for a long time without an answer or turning to charlatans, it is better to call on a health professional. »
For this nurse, it is clear that there is no question of replacing the doctor. On the other hand, this “direct access” would make it possible to detect warning signs, to be transmitted to the collaborating doctor. A position only half shared by Agnès Giannotti, general practitioner and president of the MG France union: “We want to continue working with IPAs, but the framework does not suit us. »
Work in a common place
What poses a problem for general practitioners is the risk of not being able to ensure proper follow-up of the patient if the health professionals are geographically dispersed. Together, they monitor chronic diseases such as diabetes and keep each other informed of the patient’s progress. “In health facilities, there is no problem to exchange and consult”, says Agnès Giannotti.
However, in this bill, the professional territorial health communities (CPTS), devices bringing together professionals from the same territory who wish to organize themselves around a health project, are added to the health centers. For Agnès Gianotti, the coordination between doctors and IPA will suffer. Indeed, the teams could then no longer collaborate while being in the same premises, using the same software, etc. “For it to work, you need consistency, a pair, very close cooperation between IPA and doctor”, pleads the doctor.
With the prescriptions, the fear of a drift
The other subject of the bill that poses a problem is the possibility for APNs to make prescriptions, without the opinion of the attending physician, to go see a specialist, such as a cardiologist or a neurologist. Gold, “if health professionals do not talk to each other, follow-up will be inconsistent”emphasizes Agnès Gianotti.
For her part, nurse Tatiana Henriot says she is in favor and even considers additional training necessary for APNs, if direct access is officially adopted. “The IPA needs to know the difference between what it can support and what it cannot support”, she points out.