Policy responses for France - HSRM


Policy responses for France

2.2 Workforce

Self-employed health professionals working in the ambulatory sector who experienced a significant loss of income during the lock-down period due to reduced demand for care will receive a financial aid, with a first payment early May. This aid will cover the fixed operating costs of the practice based on previous year turnover and will be available for all self-employed professionals under contract with the health insurance fund. It is estimated that visits to dentists dropped by 80% since the beginning of the lock-down, by 60% on average for specialists, by 40% for physiotherapists and mid-wives and by 30% for general practitioners. Many paramedics and dentists did not get any material or logistical help during the lock-down. It is not clear yet if they will be considered as a priority in the distribution of medical masks.

The Covid-19 sanitary crisis has triggered a debate regarding the responsibility for the provision of PPE to ambulatory healthcare providers. While the general rule is that the responsibility lies with individual employers, public or private, the obligations for self-employed health professionals were not clear. There seems to be a juridical gap there: while some people interpret that the responsibility should have lied on the state, others think that individual physicians should have taken necessary precautions and have their own stock of masks. After October 4, ambulatory care providers will no longer be able to use the national stock of masks and will have to buy their own stock of PPE.

Overall, there are only a few measures to support the health workforce working with Covid-19 patients. One major proposition, against the critical situation in nursing homes where the death toll has been very high, is to incentivise self-employed physicians and nurses to work with these residential facilities. During the height of the epidemic, nursing homes were recommended to minimize the visits from ambulatory care professionals to minimize the contagion risk. However, the lack of medical capacity in nursing homes has been problematic. Now they are allowed to contract with community-based physicians and nurses working in their own practice or in health centres. Physicians will be paid between €35 and €58 (instead of €25 for regular consultation) or they can be paid on a half-day basis (€420 per half-day). Regional health agencies are also given the right to request the requisition of ambulatory doctors in order to ensure the continuity of care in nursing homes, including when they volunteered. In this case, self-employed doctors are paid a fixed rate per hour of work, which is set based on the time of the day (for example, higher at night and even higher during weekends) (https://solidarites-sante.gouv.fr/IMG/pdf/fiche-appui-ps-ville_ehpad_covid-19.pdf).
The government will offer financial bonuses for all staff working in public hospitals whatever their occupation and position, as well as for staff working in private hospitals which participated to the handling of the sanitary crisis. This bonus will vary from €1,500 for those in the most affected regions to €500 euros for those in less affected regions or in hospitals which did not have any Covid-19 cases. Bonuses are also planned for staff working in nursing homes. They will receive €1,500 if they worked in a particularly affected region or €1,000 if they worked in a less affected region. €475 million will also be dedicated to cover the extra-costs of the epidemic (notably, the cost of protective equipment for the staff) and the loss of benefits in nursing homes (linked to the delayed admissions of new residents and the high death rates). In August, the president announced that €160 million will be distributed as bonuses (prorated on time worked) to staff who provided domestic assistance to older or disabled people at home during the Covid-19 epidemic, and who had so far been forgotten in the financial measures supporting the workforce. These bonuses will be funded conjointly by the state and local authorities (‘départements’) which are strongly involved in the planning and funding of long-term care services at home.

To face potential workforce shortage during the summer break, the Ministry of Health has launched an online platform where volunteer health professionals and hospital employees can apply to provide support to health or social care structures over the summer.

On September 15, a new decree has facilitated the recognition of Covid-19 as an occupational disease for health professionals: this recognition will be systematic for all those that have required oxygenation. For health professionals with milder forms of the disease or other professionals, the categorization of their infection into an occupational disease will be subject to an expert committee of two physicians.

Allied health students participating in the handling of the second wave of the epidemic will receive a financial compensation of €550 per month. Some hospitals have also started training some additional staff to intensive care techniques so that they can provide relief under supervision in resuscitation units.

The government supports health professionals, especially hospital staff, by assuring that their children are taken care of in selected schools or child care centers during the lock-down. Their individual roles in taking care of suspected and confirmed cases is now clearly delineated (in particular for ambulatory providers vs. hospital providers) which was not so obvious at the beginning of the epidemic. Social care workers have received less attention from the government and cross-sectors collaborations are not so well defined.

Since early March, the volunteers from the medical care reserve (created in 2007 as part of a national strategy against exceptional health situations) are asked to help healthcare professionals. These volunteers, mostly with health training such as retired nurses and physicians or students, but also medical secretaries or psychologists, can be deployed by the government in times of sanitary crisis. In the Ile-de-France region, as of March 25, 7,000 people signed up to help, including 2,500 nurses.

No specific training of health professionals in the context of the Covid-19 epidemic is in place at the national level, however local initiatives were implemented by some hospitals, and the French government and regional health agencies have provided guidelines on how to deal with suspected infected cases on their respective websites.

Moreover, some hotline services were set up to provide psychological support to healthcare professionals who are in first-line in hospitals. These services were first provided by the French National Medical Council or associations, not by the French government, which however relayed the information. On April 7, the Ministry of Health finally announced the creation of its own national telephone hotline to provide support to health professionals (including students and volunteers) working either in hospitals, in community-based settings or in nursing homes.