The number of people with chronic disease, also called long-term illness (LTD), without being monitored by a primary care doctor, is steadily increasing. At the end of 2018, 510,000 people were affected, and at the end of 2022, 714,000 people were affected, partly as a result of medical desertification. In response, the government is launching an action plan for these patients, together with Medicare.

Three key principles underlie this plan:

• respect for the patient’s freedom of choice and the professional’s freedom of exercise;
• recognition of the diversity of the regions (density and activity of health professionals), but also of actions undertaken in the departments or on which local partners wish to mobilize;
• particular attention to support for the most vulnerable, in particular residents of care facilities for dependent elderly people (Ehpad) or people with mobility difficulties.

How will this action plan be implemented?

• From the end of March 2023, a post or an e-mail from Health Insurance will be sent to all persons aged 17 years and over who are in a long-term illness (ALD) situation and without a treating doctor. Objective of this communication: to inform about the support offered by the Health Insurance in their search for a doctor. Affected people may object to the procedure and refuse to pass on information to doctors. They will have one month to demonstrate their refusal.
• In concrete terms, the Health Insurance will thus identify patients aged 17 and over who have consulted the same doctor 3 times in the year, without the latter being declared as their treating doctor. Approximately 183,000 patients are estimated to be affected.
• She will then send each doctor a list of ALD patients he sees at least 3 times a year without being their treating doctor, inviting the practitioner to agree to become one. If he accepts, the Health Insurance can help patients to finalize the process of declaring a treating doctor.

Several other actions will then be supported by the health stakeholders in the territories (territorial health professional communities or CPTS, multi-professional health homes, health centers).

At the departmental level, a steering body must also bring together the following stakeholders: health insurance organizations, the regional health agency (ARS), the prefecture, representatives of health professionals, coordinated exercise structures (nursing homes and health centers), CPTS, local elected representatives or patient associations.