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France's neighbourhood healthcare centres: easier access to quality care

In France the neighbourhood healthcare centres known as "maisons de santé" are gaining ground, often as a way to work collaboratively and to offer new services.

A "maison de santé", literally "house of health", is defined in France as a grouping of medical and paramedical professionals in a shared healthcare project. In reality, the type of organisation may depend upon the local conditions as well as the type of practice the professionals choose: either physical groupings in "centres", or else functional groupings in "poles" organised around a joint healthcare project shared by professionals practising in different locations.

There are, depending on the definition, between 600 and 1700 such healthcare centres in France. Centres that offer full-time access to consultations with general practitioners to the public at large, and bring together several different professions, are thought to number around 300 in France and are mostly located on the outskirts of very large urban areas. A hypothetical number of 4 000 healthcare centres spread out to cover all of France over the short or longer term would be equivalent to one centre per "canton" or cluster of municipalities.

Professional groupings carry the hope of lowered obstacles to care, better practices and more public health measures. However the desire to work together remains ambiguous in terms of how roles and tasks are shared and in terms of how patients fit in, since healthcare professionals have a variety of reasons for no longer wishing to work on their own.

Group practice still represents a minority in France, as it does in Germany, Belgium and Italy, while it is in the majority in Finland, Sweden the United Kingdom, Canada and the Netherlands. Experimentation got underway in the USA in 2006.

Much remains to be done to make "working together" a reality in France: getting pharmacists involved, cooperating with the hospital and home-healthcare sectors, improving conditions, involving patients and sharing work between various healthcare professionals.

©Prescrire 1 August 2012

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