Doctors - all change next year

[Will]

I have learned from a normally reliable French person that next year things are changing with regard to doctors. The system will become much closer to UK practice.

All residents will be obliged to choose a 'médicin traitant', which will normally be their usual GP. This will be applied from 1 July - before then all assured people will be contacted to nominate a doctor. This doctor will in future be responsible for keeping your medical records. You will only be able to see a specialist if you get a letter from your nominated doctor - exceptions being ophthalmologists, gynaecologists and paediatricians. This takes effect from 1 January.

If you do not comply with this, you will be charged a supplement or not reimbursed by your caisse.

http://www.lemonde.fr/web/article/0,1-0@2-3224,36-391070,0.html

It seems to be very similar to the UK registration system, except that you are free to choose any doctor and will not be forced to use a particular cabinet.

[Pucette<P><FONT face="Times New Roman" size=3>Pucette<FONT><P><FONT face="Times New Roman" size=3><P class=MsoNormal style="MARGIN: 0cm 0cm 0pt">"Qui ne connaît pas la campagne lhiver, ne connaît pas la campagne et ne connaît pas]

Aren't you free to choose your gp in the uk any more?

Puzzled Pucette

[Will]

I believe the choice in UK is limited, to say the least - I think that if our daughter, who lives in our English house, says that she's living there rather than where she was before (which was only a couple of miles outside town) she would have to change doctors. I'm sure those who still live in GB will be able to clarify this. I get puzzled by the NHS too.

Whereas in France our doctor is 15km away (in the commune where we used to live) and I'm sure we'll be able to choose her.

This is a good link about the changes in France: http://info.france2.fr/dossiers/france/6787151-fr.php

[GRT17]

Pucette

Yes, AFAIK in the U.K. you are free to choose a G.P and you register with that practice. You can also opt to change your G.P. if you are not happy with the chosen one. Many of them have now adopted the policy that you can telephone in the morning and will be seen that day by one of the doctors on duty.

Things have changed quite a lot over the last year.

Gill

[I1]

Out of interest, I believe that in the UK a doctor receives money for having somebody registered. Is the same going to happen in France or is everything funding wise the same except that you are limited to a single surgery.

I ask mainly from interest and as to whether the French GPs regard it as a positive move or negative (in they now have to keep medical records, paperwork, etc.)

[Alexis]

They have been discussing this in the papers and on the telly for months now.  All it means is that the more hypochondriac French will not be able to go to several doctors to see which of their views matches their neighbours!  Only one can recommend you to a specialist.  My OH has two doctors......!

This will also cut down the drug bill as only one doctor will prescribe.  Usually.

My doctor is 25 km away.  He is very generous with the old sick note

Where does the idea come from that the doctors here don't keep records?

[Pucette<P><FONT face="Times New Roman" size=3>Pucette<FONT><P><FONT face="Times New Roman" size=3><P class=MsoNormal style="MARGIN: 0cm 0cm 0pt">"Qui ne connaît pas la campagne lhiver, ne connaît pas la campagne et ne connaît pas]

Thank you, as I understand it one is at least in principle free to choose one's GP in the UK; the limiting factor is on the GP's side, they will only take on so many patients, and in some areas this means little choice. Indeed some find themselves refused by all and sundry, but the NHS is obliged to find a GP for pretty much everyone. It is common in London for GPs not to accept patients from more than a certain distance away.

Patients who require regular home visits in France are restricted in their choice, albeit for different reasons. Elderly neighbours choose relatively local GPs because the extra mileage charge for home visits is not covered for more distant ones, and they need a lot of home visits. This now limits them to I think a choice of 2 (there were more but some have themselves retired and the practices been discontinued).

As Alexis says the changes have been widely publicised and a long time coming; it is hoped that they will cut costs dramatically.

[I1]

“Where does the idea come from that the doctors here don't keep records?” In my case through lack of knowledge and the assumption that in a totally de-centralised system who keeps the records (e.g. you visit 3 different doctors, who holds what records ad can these be referenced by other doctors who probably don’t know who you visited and when, etc.).

[I1]

[quote]Thank you, as I understand it one is at least in principle free to choose one's GP in the UK; the limiting factor is on the GP's side, they will only take on so many patients, and in some areas this m...[/quote]

When I last registered in the UK, it was a complete nightmare. I was in single, no children, in my early 40's, had not seen a doctor for years, etc. yet practices 3 miles away were rejecting me because I was "too far away". In the end I had a choice of one (that was actually 4 miles away. This was not in London. I had the impression that the practices were "cherry picking" the easiest patients. Any hint of having to do anything atall inconvenient (like travel for a home visit) and they would not take you.

[Iceni]

Of course they will cherry pick - who would want "high maintenance" patients e.g elderly that will require lots of visits, drugs etc. In 21st century England the NHS is about budgets, league tables etc, not about caring and curing.

John - who BTW no longer has to worry or care about what happens in a foreign country - perhaps I never have.

[Iceni]

[quote]PucetteYes, AFAIK in the U.K. you are free to choose a G.P and you register with that practice. You can also opt to change your G.P. if you are not happy with the chosen one. Many of them have now ado...[/quote]

When the new system came into our GP's practice in the UK it caused uproar and was talked about in the Parish Council meetings but it came from 'he who's name is B.Lair' so he obviously knew better than doctors.

1 Elderly people and others who needed repeat visits could not make the appointment after the latest visit but had to sit by the phone and keep ringing until they got through in the hope that they would get an appointment on the due day - ie the day of the next appointment and not in advance.

2 Most no longer got the GP that normally saw them as they had to take what was available and could not make an appointment for even the next day unless they went through the whole procedure again.

3 As all patients were 'whisked' through as everyone had to be seen that day, long appointments were no longer easy to get and in one case a serious illness was missed by a GP who said that this was because of time constraints.

4 I was waiting to see my GP when a neighbour came in very distressed and asked to see a doctor urgently, she was refused and told to phone in the next day - that was the first time I had ever seen this, when I had wanted an urgent appointment in the past I had just been told I would have to wait until the end.

The overall view was the system was retrograde but GP's had to do what they were told.

Personally, I have been taken off most of my medication since I have been in France, and not very long ago the drugs I was on were proven to be a risk for heart attack and other problems. All I got in the UK was an increase in dosage every time I went, here, the GP was very concerned as I had high blood pressure and he was sure that the drugs were the cause - he was right. The consultation took over 20 mins - and it was not the first time I had seen him.

Lets all pray that the French system does not follow the Britsh system.

[Ron Avery]

[quote]PucetteYes, AFAIK in the U.K. you are free to choose a G.P and you register with that practice. You can also opt to change your G.P. if you are not happy with the chosen one. Many of them have now ado...[/quote]

French doctors do not keep your records or X-rays, you do, although this may change if we are allocated doctors.

No you cannot just choose any doctor in the UK and you never have been able to.  There is an element of choice where there are a number of doctors at the same surgery or at nearby practice where there is more than one in in a town, but you do not have a free choice of  doctor.  The reason is geographical and they will not take on patients outside of their call areas.  We moved just 5 miles and our town based doctors of 25 years told us we had to change to a nearer village based surgery as they would not come out to us on a visit.  The other comments about appointments and patients being turned away are thankfully very much an exception, although there are some poor practices stil in the UK, but each practice has its own rules about appointments and 99% of surgeries will see a patient in an emergency, provided that the patient is one of theirs, and anyway, if it is a real emergencythat needs instant treatment,  why go to the doctors and not dial 999?

The advantages of the new larger practices is that if you are not fussy about which doctor you see, you can normally get seen by a doctor very quickly and they do many tests and minor operations previously only done at hospitals.

[Alexis]

French doctors do keep your records.  X-rays are given to the patient on leaving the department and it is up to you to take them to your doctor.  He recieves a copy of the report though.

Mine does, anyway.

It was on the telly last night again.  You will be free to make appointments directly with your gynaecologist, paediatrician and opthalmo.  If you have a 'long' illness such as heart trouble, cancer or diabetes you can also go directly.  Other things were discussed but I was in bed and think I dropped off!

[Will]

The obligation on French GPs to keep proper medical records for their patients is one of the key points of the new system, though this is some time in the future rather than in the next few months. Most GPs in France keep some sort of record, though with the previous freedom to see any doctor there was a reliance on the patient to give relevant information to any doctor other than the usual one. Our own French GP has no receptionist, clerk, nurse etc as the equivalent would in UK - not even any computer - and the 'record' is basically an index card for each patient.

If you have a long-term condition you can nominate the specialist who deals with that as your 'medicin traitant' so that you don't have to go to your GP everytime you need the specialist. I don't know if that means that should you need a different specialist for a different condition you have to be referred by your usual specialist - presumably it does?

Yes, it does look as if attempts to streamline the UK system have created even more difficulties without really solving the problems they were supposed to, and the bureaucracy involved in the revised French system could be equally horrific.

And it is true that the impetus behind the changes in France, which have indeed been discussed for some time but are only now being introduced, is the way that the cost of health provision, medicines in particular, has spiralled out of control and was a serious concern for both the state system and providers of topup insurance. It was, I am told, very common for French people to visit several doctors when they had a problem so that they got a large quantity, and often a wide selection, of drugs.

[GRT17]

Ron A

re. choosing a doctor in the U.K. I was referring to having a choice within a practice or city/ town of reasonable size. Of course it would be impractical to be registered with a doctor who is based miles from where you live.

Di. (Iceni)I can only comment on my own experience and to date it has mostly been good.

Good luck to all with your G.P.s whichever country you are in!

Gill

[Jon 1]

I think this is a retrograde step as far as the majority of clients are concerned and possibly more costly for the health system.  The French system has been very client centered with freedom of choice.  This meant that GPs and Specialists were paid by results (and bedside manner), leading to better interaction between client and professional.  This system could change the balance of power away from the patient.  We could see similarities to the UK system, with more arrogant GPs and Specialists. Although the regs say that you are free to change your GP this may become more difficult as is the case in the UK.  French GPs are now to become gate keepers in the system as is the case in the UK.  This could slow the system down and create bottlenecks as in the UK system.  It will certainly take longer for GP appointments now that everyone will have to go through this funnel to avoid financial penalties.  It also increases costs because where you could previously go directly to the Specialist of your choice there is now an intermediary requiring payment.  So instead of 40 euros to visit the Specialist it will be 40 euros plus 20 euros for the intermediary.  Has all this been properly thought through?  The new system also discriminates in favour of the rich who can still use the system as before.  It also states that the GP will direct the patient towards a specialist of their choice 'in liaison with the patient'.  If this latter part is not upheld the element of choice and empowerment that the French have experienced will disappear.  It could also lead to a 'buddy system' where the GP may have a vested interest in passing you on to his/her buddy.  Talking to a German Consultant it seems that Germany is moving over to the UK model and he left Germany to practice in France because of this.  It seems he may have jumped ship too early!  I am surprised that the French and the Specialists are willing to accept this new model without resistance.

[CJJL<HR>Si jeunesse savait! Si vieillesse pouvait...]

[quote]I have learned from a normally reliable French person that next year things are changing with regard to doctors. The system will become much closer to UK practice. All residents will be obliged to ch...[/quote]

From the horse's mouth

(If you read French, it's really worth registering for the newsletter... http://www.service-public.fr/accueil)

LETTRE SERVICE-PUBLIC.FR NUMERO 212 DU 17 DECEMBRE 2004

ACTUALITES SANTE -

Assurance maladie : les assurés doivent choisir leur médecin traitant début 2005. Au début de l'année 2005, chaque assuré social de plus de 16 ans devra

choisir un "médecin traitant", généraliste ou spécialiste, sous peine de moindre remboursement des soins. Cette nouvelle règle a été instaurée

par la loi du 13 août 2004 réformant l'assurance maladie.

http://www.service-public.fr/accueil/sante_choix_medecin_traitant.html

What it says: from begining of 2005, all persons over 16 registered with a CPAM will have to select their own doctor, Gp or specialist or will risk getting a lesser reimbursement. (copy the link to read more, in French!)

There you go!

[Alexis]

Now that I have read the article in OF, I remember everything!!!

You are not forbidden to go directly to a specialist, it just costs you more and you will not be re-imbursed that extra cost.  If, for example, it costs 30€ with your treating doctor's letter, it will cost say 35€ if you go directly and you will not receive this 5€.

Pyschiatrists still haven't been classed as go directly or recommended.

[I1]

[quote]When the new system came into our GP's practice in the UK it caused uproar and was talked about in the Parish Council meetings but it came from 'he who's name is B. Lair' so he obviously knew better t...[/quote]

Having just returned from a visit to the UK I am horrified by the state of the UK GP system. My father has what may be a serious condition but has so far been unable to see his GP because, from 8:30 am there is a queue outside the surgery (which opens at 9:00am) thus all appointments for the day are pretty well taken before anybody actually gets into the surgery. If you try to phone it’s just dial, hang-up, re-dial, etc. and you never get through (always engaged). However, they do have a couple of afternoons each week when you can make advanced appointments and he has managed to get one of these for 2 weeks away.

People cannot complain as they risk being told to find another surgery. They have tried other means to see the doctor but it is not an emergency (i.e. go to A&E) and the GP surgery can do nothing due to the governments new rules (10 minute appointments, etc.)

Meanwhile he is extremely uncomfortable, his condition is worsening, yet he cannot see any specialist, etc. until he has been seen by his GP. And our UK government is going on about how much better things are.

[Teamedup]

Il, must depend where you live as we had absolutely no problem getting an appointment at a GP's in the UK when we were back. One phone's at 8.30 and one is given for later in the day. I asked friends and it seems to be the same just about all over our little part of the NE.

I have never known a doctor keep X Rays here. I feel it will be the decline and begining of the fall  of the system if the GP's end up being overloaded with admin.

I'm going to have to go and discuss this with our GP's, one at least is very unhappy about it all.

[French Kat in England]

Aren't you free to choose your gp in the uk any more?

I have lived in England for 4 years now, and my personal experience about GPs in the UK is that you don't have a choice of surgeries. You just have to go to the one of your catchment area. Then you don't have a choice over your chosen doctor but you can ask to change it later.

My surgery being quite busy are starting to refuse new patients. For example, my boyfriend couldn't go to it (but I was accepted as I had never been registered before), and had to stay with the surgery he was already registered in before we moved, which is a bit further away but in the same town.

I don't go there very often luckily, but when I do need to go, I hardly get to see my designed doctor anyway. You have to ring at 8:00 am and you get an appointment the same day with any doctor available in that same surgery. More often than not, they tell you that there is no appointments available and you have to ring again the next day. That can go on for 2 or 3 days  before you get seen

I thought it was my surgery being a bit ackward but from your input, I see now that it is common pratice.

French Kat in England

[Ron Avery]

The forms are going out now, some friends brought one sent to their parents for me to translate for them.  The form has to be completed by the Doctor and patient and returned to CPAM and the system will be in place by July 2005.

An accompanying letter also told them that from now on they will have to pay €1 ( they are both 80+) to see the doctor and as reported earlier on this thread before it lost its way, will need referrals from the Doctor in future to see a specialist,

[CJJL<HR>Si jeunesse savait! Si vieillesse pouvait...]

[quote]The forms are going out now, some friends brought one sent to their parents for me to translate for them. The form has to be completed by the Doctor and patient and returned to CPAM and the system wi...[/quote]

"as reported earlier on this thread before it lost its way, will need referrals from the Doctor in future to see a specialist"

I don't believe this is the case at all.

You will still be able to see any specialist you want without any referral from your French GP.

You will however NOT get as much money back without a referral as you would with a referral.

From what I have seen where I live, a lot of people go to the doctor's at the drop of a hat for the slightest twinge or cut. Nothing is ever as simple as indigestion, it's a "gastro"; not for them a simple cold, it's bound to be bronchitis!

They keep going from one surgery to another until the GP's diagnosis matches their own opinion, safe in the kowledge that they are getting their money back either from the CPAM or from their mutuelle (usually paid for through their employment). It's the same with their visit to a specialist.

They spew out the most incredibly knowledgeable medical term to describe their ailment, convinced that theirs is a unique case, deserving a large number of tests, injections, tablets, ointments and other medication, which will then accumulate in a drawer until the next visit to the chemist with yet another prescription all ready to be reimbursed!

The main problem I have had since moving to France has been my frustration at having to go to a pharmacie for the most basic painkiller, instead of being able to buy it when I do my supermarket shopping... I did get used to being treated as responsible adult, rather than someone unable to take charge of the most basic medication.

(ps: yes I am French!)

[Ron Avery]

"You will need referrals from the Doctor in future to see a specialist" 

Only quoting from the letter I was shown from CPAM, if you know better than CPAM CJJL then fine.

"From what I have seen where I live, a lot of people go to the doctor's at the drop of a hat"

A bit of a generalisation here me thinks, you sit outside the Doc's all day when there is all that lovely countryside to view?   I doubt that the average paysan has €20 a time to keep paying out to see the Doctor, even if they do get € 14 back.  Anyway look on the bright side all those supposed timewasters of yours will be now paying.  Under the new system, all those visits will cost a €1,  that should soon reduce the Health defecit

[CJJL<HR>Si jeunesse savait! Si vieillesse pouvait...]

[quote]"You will need referrals from the Doctor in future to see a specialist" Only quoting from the letter I was shown from CPAM, if you know better than CPAM CJJL then fine. "From what I have seen wher...[/quote]

You seem to take this rather personally Ron! All I did was to express an opinion, which happened to differ from yours...

I have checked again with www.Ameli.fr and I repeat: after 01/07/2005, you will be able to see a specialist without referral from your GP but you will not get as much money back as if you had been referred.

Regarding your other point: I do happen to spend a lot of time at the doctor's surgery... I could even say that I work there...

Most people don't pay €20 or even €14, as they have a mutuelle, which take care of the payment not covered by the CPAM. I say MOST, not ALL...

I did not call thesespeople "timewasters". What I am saying is that most people I see are conditioned into thinking that a visit to the doctor's is essential for the slightest ailment.

I have no view on the deficit, sarcastic or otherwise!