Coordinated Primary Care Team to Access and Regulate Unscheduled Care

Condition(s) studied

Study summary

Unscheduled care is care "that does not constitute a life-threatening emergency but for which treatment by a healthcare professional is desirable within 48 hours" and 80% of general practitioners organize their schedules to provide unscheduled care each day. In Multidisciplinary Health Centers, 58% of general practitioners report that they systematically address requests for unscheduled care through a collective response to these requests.

Despite this, difficulties in accessing healthcare are worsening and according to a survey by France Asso Santé, 44% of French people report that they have already foregone healthcare due to excessively long waiting times, and in 2025, 80% reported having foregone care at least once, with 67% claiming this is due to excessively long waiting times for appointments.

The literature shows that it is linked to two main factors: precarious living conditions (financial barriers) and limited healthcare availability, which reinforce one another, as people living in poor conditions are three times more likely to forego care than others.Indeed, in areas underserved by general practitioners, this risk becomes more than eight times higher than that of the rest of the population.

Nationwide, the density of general practitioners was 153 GPs per 100,000 residents in 2012 and 140 per 100,000 in 2021; it is expected to continue declining over the next decade. GPs work work an average of 55 hours per week and, as their number is declining, it is essential to reorganize primary care services.Regarding non-emergency care, in 2019 17% of French people reported that they had sought emergency room care because no doctors were available (according to a survey by France Asso Santé). Many visits to the emergency room could be avoided because they fall under the purview of community-based care. This misuse appears to be linked to several factors, including the lack of availability of appropriate primary care and the greater financial accessibility of third-party payment, which is consistent with the factors leading to forgoing care. In Occitanie, the 2024 ORU report found that 20% of emergency department visits could potentially be handled by primary care. Changes in the organization of community health services are gradually emerging, notably thanks to task delegation and the creation of coordinated care structures but this has not been sufficient to prevent a deterioration in access to community-based care. The medical team at the La Source MSPU is well aware of this public health issue and the inequality in access to care for all. In light of this, the MSPU proposes to organize a primary care team to manage access to and coordinate unscheduled care services within the organization. This innovative structure is referred to as the Coordinated Structure for Unscheduled Care (SC-SNP). A walk-in consultation window is open every morning from Monday through Friday to address requests for unplanned care. This system mobilizes a dedicated primary care team consisting of a medical assistant, a registered nurse, and a general practitioner.

Eligibility

Primary outcome measure(s)

• Number of consultations per hour for walk-in care BEFORE implementing the Controlled Structure for Unscheduled Care at the La Source MSPU — Baseline
  The aim is to compare the number of consultations per hour for walk-in care before and after the implementation of the Controlled Structure for Unscheduled Care at the La Source MSPU, over a 6-month period.
• Number of consultations per hour for walk-in care AFTER implementing the Controlled Structure for Unscheduled Care at the La Source MSPU — After 6 months
  The aim is to compare the number of consultations per hour for walk-in care before and after the implementation of the Controlled Structure for Unscheduled Care at the La Source MSPU, over a 6-month period.

Trial sites (2)

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