Territorial professional health communities are developing in Haute-Loire to combat medical deserts

Faced with the difficulties related to access to care, the Professional Territorial Health Communities (CPTS) seem to represent an interesting solution. Non-existent five years ago, they are developing more and more, even in Haute-Loire where the former was born in December 2020, in the north of the department. But what is a CPTS? The institution was born from the will of the health workers of a specific territory to federate, coordinate their actions to improve the care path for users. Each CPTS is organized around a health project. “It is a true cultural revolution. Professionals take charge of a territory and organize it. Together we can do better than alone in our corner ”, explains Roland Rabeyrin, general practitioner in Puy-en-Velay on the initiative of CPTS Velay Sud. based on the needs of the local population “, continues Gilbert Poinas, promoter member of the CPTS of Brivadois, whose pre-project has just been validated by the Auvergne-Rhône-Alpes Regional Health Agency (ARS).

Mandatory missions

The goal is to fully cover the Haute-Loire by 2023. “The scope of the CPTS is established on the basis of the location, the attractiveness of the territory”, underlines Gilbert Poinas. Consequently, some municipalities in Altiligeri are annexed to the CPTS of Ondaine, in the Loire.
Two CPTS are currently active in the department: the Sud Velay community and the Nord Velay Forez community. Two others have recently seen their pre-project validated: that of Brivadois and that of Rives du Haut-Allier. And the president of the latter, Sibyl Chabanon, to specify. “We have to work together. Otherwise, we quickly find ourselves stuck. “

Allow patients without a doctor to have an appointment

To exist and obtain funding from the regional health agency

, each community must respond to mandatory missions, the first of which is accessing a general practitioner and improving the management of extraordinary care. “In Haute-Loire, about 9% of the inhabitants do not have a doctor”, stresses Frédéric Brance, director of the Haute-Loire CPAM. “Within the Velay CPTS, for example, doctors are asked to keep spaces, every day, for extraordinary care. The goal is to combine this agenda in order to refer patients to a doctor who can receive them quickly, ”insists Roland Rabeyrin.

“It’s also something that helps unlock emergencies.” Frederic Brance

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The second mandatory mission is to organize the patient’s journey, ensuring better coordination of the actors: general practitioner, specialist, private nurses, etc. This obligation takes on its full meaning when an dependent and isolated elderly person leaves the hospital. “In the past we lacked anticipation. Here, we are a bit of a link between the hospital and the city, by contacting, for example, the nurse who will provide home care, “says Cécile Roche, coordinator of CPTS Nord Velay Forez.” For example, Mr. X leaves the ‘hospital. The CPTS is informed and calls a nurse, a doctor, a physiotherapist, a pharmacist and even the ADMR, if necessary, so that the patient, when he returns home, can have everything he needs “, supports Dr. Serge Piroux, general practitioner in Craponne-sur-Arzon and on the initiative of the CPTS Nord Velay Forez.
The other two mandatory missions concern preventive actions to, among other things, improve cancer screening and respond to serious health crises, such as that of Covid.

But a CPTS is not intended to operate autonomously. “The goal is also to communicate with each other, exchange, establish similar protocols”, insists Serge Piroux. “The interest for us is really working together, not being alone anymore”, underlines Géraldine Bonnet, liberal nurse involved in the creation of the CPTS Velay Sud. In this approach, professionals can also count on multidisciplinary health centers, to prevent Haute-Loire becomes a great medical desert.

Manuel Cladière

When the pre-project is validated, a CPTS receives a grant of € 15,000 which should allow him to structure his project. It also benefits from a loan from the Health Insurance, determined on the basis of the number of inhabitants covered, which can vary from € 287,500 to € 580,000.

CPTS Nord Velay Forez, a pioneer in the department

CPTS Nord Velay Forez is the first to be created in Haute-Loire. It was created in 2021 on the initiative of Dr. Serge Piroux.

“We have caregivers on its territory, we also have to take care of them so that they stay”, according to Céline Roche. Photo of the illustration SP

The Territorial Professional Health Community of North Velay Forez covers 71 municipalities in the Haute-Loire, Puy-de-Dôme and Loire. “The perimeter was determined on the basis of the habits of the inhabitants”, explains Céline Roche, coordinator of the CPTS. In office since September 2021, she specifies: “The Covid crisis has highlighted the needs and problems of the area. The first thoughts on the creation of a CPTS date back to the year 2020. It took a year to create the entity ”.
“Taking care of caregivers”

Like all CPTS, the one in the north of the Haute-Loire must guarantee mandatory missions, but it has also set other objectives. “The first is about low back pain. We have begun working with health professionals to improve the relevance and quality of care, “says Céline Roche. The second optional mission directly concerns the health care workers themselves.” The Covid crisis has shown that they too are suffering. caregivers in your area, you have to take care of them so that they stay. We recently organized an evening with a conference, workshops and intervention groups. There is a real need to offer something for professionals throughout the year “, he insists.

“We want to facilitate the work of established health workers, but also to attract new doctors”, concludes Serge Piroux, general practitioner in Craponne-sur-Arzon.Focus now on the east and south, not covered

While the CPTS now covers much of the west and north of the Haute-Loire, the Yssingelais and the granite plateau currently have none. But things could change quickly.
The goal is to completely cover the department. photo cm

The will of the ARS Auvergne-Rhône-Alpes and the CPAM of the Haute-Loire is to “cover the entire department with the CPTS. There are contacts in the Yssingelais to see a structure emerge, ”says Frédéric Brance, director of the Haute-Loire Primary Health Insurance Fund. “The desire is to create a single large CPTS in Yssingelais”, continues Loïc Biot, director of the ARS Auvergne-Rhône-Alpes altiligera delegation.

As for the south of the department, “a project is taking shape with the municipalities outside the department”, slips Frédéric Brance. It seems that he is forming a CPTS with the north of Lozère.

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