French GPs angry at proposed fines over online paperwork

French GPs are angry after parliament voted through a law that will see them fined up to €10,000 a year from 2028 if they do not fill out forms for the dossier médical partagé (DMP) of their patients.

The measure was thrown out by the Conseil constitutionnel, the highest court in the land for constitutional matters, but the government has said it will reframe the law later.

The DMP is a digital platform which for patients is found at monespacesante.fr, the voluntary government health website.

It should contain a record of your visits to doctors (both GPs and specialists), as well as prescriptions, X-rays, laboratory reports, hospital discharge reports and details of payments.

Other uses include a health questionnaire, details of free health check-ups that are available and forms to ask for them, and reminders for regular check-ups with a dentist or other professionals.

The threat to charge doctors if they did not fill in the DMP was one of the reasons for the multi-union 10-day strike by GPs and many private clinics at the start of January.

“It is a computer system which they have spent hundreds of millions of euros on, and they want to force it on us when we have shown that it simply does not work,” Dr Sophie Bauer, the president of the Syndicat de médecins libéraux, one of the main unions for family doctors, told The Connexion.

“The strike is for many reasons, but I can say that for most of the doctors on strike the DMP fine proposal was the straw which broke the camel’s back.”

While the interface for the 17 million patients who use the system has improved, especially for those with fast computers and fibre-optic connections, doctors say their side of the system is dated and hard to use.

“It takes between five and 10 minutes for a well-trained and computer-savvy doctor to get a patient’s file from the system and find the information they want from that file,” said Dr Bauer.

“That whole time they have to be concentrating on the computer and not on the patient.

“And then after the consultation it takes more time to upload the report of what happened!

“The idea might be good but for it to work in practice the whole existing system should be scrapped and rebuilt so it works,” said Dr Bauer.

She said many older GPs still used paper-based filing systems for their patients.

Younger doctors either used computer filing systems, or a mix of computers and paper.

“There are many, many different software packages for doctors to choose from, and the choice they make is one which suits them and they are comfortable with,” she said.

“But these different systems do not talk to each other, and it is very difficult to get them to talk to the DMP.”

Institutional discrimination

Dr Bauer said it also reflected institutional discrimination against older people in the health service.

“For people aged under 70, there is a reasonable chance that they will be able to use the system, and if necessary find documents and print them out to take to the doctor if they have questions.

“But I find many people over 80 are simply not able to do things like that. They are discriminated against by this move to go paperless.”

Monespacesante.fr is one of four health-related platforms French people are expected to sign up to.

Ameli.fr is now the main contact for l’Assurance Maladie, the system of local or industrial caisses which manage the financing of the health system. It has replaced the letters which used to be sent out showing repayments for medical treatment.

Almost all mutuelle complementary health insurance companies now also insist on clients using their web or app platforms. 

They can require unique passwords for every member of the family covered by a mutuelle, which must be different to the one to enter the general insurance sections of their websites.

Finally, residents in France are now able to download a digital version of their carte Vitale health card, as a smartphone app was rolled out nationwide last November. 

It is the final step in a long-running process to digitise the health cards, however there are no plans to end physical versions, which are still accepted at all pharmacies and doctors’ surgeries. Indeed, not all medical facilities are currently equipped to accept digital versions of the card.

What else are doctors in France unhappy about?

The row over the DMP is only one of doctors’ complaints concerning new budget proposals. Others include:

• A crackdown on sick notes (arrêts de travail). These trigger rights to some social security grants as well as sick pay. The government wants tighter controls while doctors say it is insulting to imply they deliberately help people defraud the system.

• Proposals from the government that it, alone, can decide payment for some medical procedures when it cannot get agreement from medical unions.

• A proposal that the cost of medicines prescribed by a doctor be compared automatically with the cost of prescriptions written by other doctors in the area.

• A scheme to give junior doctors more experience in training has not been implemented. They should be offered a year’s training to be GPs in the field but say no places are available, despite GP shortages, and they are forced to do it in hospitals instead.

• General loss of confidence in the political system. Médecins libéraux (independent doctors, ie. those not working directly for the state in public institutions) accuse the government of wanting to reshape France’s medical system into one fully under state control, without consulting the people or health professionals.