Coordinated Primary Care Team to Access and Regulate Unscheduled Care

Unscheduled care refers to care "that does not constitute a life-threatening emergency but for which treatment by a healthcare professional is desirable within 48 hours" (1).

Eighty percent of general practitioners organize their schedules to provide unscheduled care on a daily basis. In Multidisciplinary Health Centers (MHCs), 58% of general practitioners report that they systematically address requests for unscheduled care through a collective response to these requests. Despite these efforts, difficulties in accessing healthcare are worsening: in 2019, 44% of French people reported having already foregone healthcare due to excessively long wait times, according to a survey by France Asso Santé, and by 2025, 80% of French people reported having foregone care at least once, with 67% citing excessively long wait times for appointments as the reason. Forgoing healthcare is a reality in France, and the literature shows that it is linked to two main factors: precarious living conditions (financial barriers) and limited healthcare availability, which reinforce one another, since people living in poor conditions are three times more likely to forgo care than others but in an area underserved by general practitioners, this risk becomes more than eight times higher than that of the rest of the population.

Nationwide, the density of general practitioners (GPs) was 153 GPs per 100,000 residents in 2012 and 140 per 100,000 in 2021; it is expected to continue declining over the next decade. With general practitioners working an average of 55 hours per week and a declining population, the reorganization of primary care services is a necessity. The challenges facing primary care services have repercussions throughout the entire healthcare system: regarding non-emergency care, 17% of French people reported in 2019 that they had sought emergency room care because no doctor was available, according to a survey by France Asso Santé. The HCAAM report from 2022 notes that "many visits to the emergency room could be avoided because they fall under the purview of community-based care"; this misuse appears to be linked to several factors, including the lack of availability of appropriate primary care and the greater financial accessibility of the SAU (third-party payment), which is consistent with the factors leading to forgoing care. In Occitanie, the 2024 ORU report found that 20% of emergency department visits could potentially be handled by primary care.

The effectiveness and efficiency of primary health care have been demonstrated internationally, as has its ability to reduce social inequalities in health, particularly through interventions in primary care. In 2018, in the Declaration of Astana, the World Health Organization (WHO) affirmed that Primary Health Care is "the cornerstone of a sustainable health system with a view to universal health coverage." In France, to reduce the forgoing of care and the incidence of health-related social issues, it would be necessary to reorganize the French healthcare system around primary care, which is currently only minimally organized, planned, and regulated.Changes in the organization of community health services are beginning to emerge, notably through the expansion of task delegation and the creation of coordinated care structures (MHCs, Territorial Professional Health Communities (CPTS)), but this has not been sufficient to prevent a deterioration in access to community-based care. This is the conclusion reached by the High Council for the Future of Health Insurance (HCAAM) in its 2022 report on primary care, "Organization of Community-Based Care: Ensuring Access to Quality Care for All," in which it emphasizes the need "to expand and accelerate these transformations, but also,to find short-term solutions to guarantee adequate access to care everywhere.".

The medical team at the La Source MSPU is well aware of this public health issue and the inequality in access to care for all. In light of this, the MSPU proposes to organize a primary care team to manage access to and coordinate unscheduled care services within the organization. This innovative structure is referred to as the Coordinated Structure for Unscheduled Care (SC-SNP). A walk-in consultation window is open every morning from Monday through Friday to address requests for unplanned care. This system mobilizes a dedicated primary care team consisting of a medical assistant, a registered nurse, and a general practitioner.

Primary outcomes

• Number of consultations per hour for walk-in care BEFORE implementing the Controlled Structure for Unscheduled Care at the La Source MSPU [Baseline]: The aim is to compare the number of consultations per hour for walk-in care before and after the implementation of the Controlled Structure for Unscheduled Care at the La Source MSPU, over a 6-month period.
• Number of consultations per hour for walk-in care AFTER implementing the Controlled Structure for Unscheduled Care at the La Source MSPU [After 6 months]: The aim is to compare the number of consultations per hour for walk-in care before and after the implementation of the Controlled Structure for Unscheduled Care at the La Source MSPU, over a 6-month period.

Secondary outcomes

• Proportion of requests for unscheduled care according to reason [After 6 months]: Quantitative
• Proportion of requests for unscheduled care by category : medical referral by the controlled structure for unscheduled care [After 6 months]: The aim is to estimate the proportion of responses by category (medical referral by the controlled structure for unscheduled care, paramedical referral by the controlled structure for unscheduled care, consultation within < 48 hours, < 7 days, > 7 days) and the proportion of responses per qualification
• Proportion of requests for unscheduled care by category : paramedical referral by the controlled structure for unscheduled care [After 6 months]: The aim is to estimate the proportion of responses by category (medical referral by the controlled structure for unscheduled care, paramedical referral by the controlled structure for unscheduled care, consultation within < 48 hours, < 7 days, > 7 days) and the proportion of responses per qualification
• Proportion of requests for unscheduled care by category : medical referral by the controlled structure for unscheduled care within 48 hours [After 6 months]: The aim is to estimate the proportion of responses by category (medical referral by the controlled structure for unscheduled care, paramedical referral by the controlled structure for unscheduled care, consultation within < 48 hours, < 7 days, > 7 days) and the proportion of responses per qualification
• Proportion of requests for unscheduled care by category : medical referral by the controlled structure for unscheduled care within < 7 days [After 6 months]: The aim is to estimate the proportion of responses by category (medical referral by the controlled structure for unscheduled care, paramedical referral by the controlled structure for unscheduled care, consultation within < 48 hours, < 7 days, > 7 days) and the proportion of responses per qualification
• Proportion of requests for unscheduled care by category : medical referral by the controlled structure for unscheduled care > 7 days [After 6 months]: The aim is to estimate the proportion of responses by category (medical referral by the controlled structure for unscheduled care, paramedical referral by the controlled structure for unscheduled care, consultation within < 48 hours, < 7 days, > 7 days) and the proportion of responses per qualification
• Patient satisfaction adapted version of the University of Sheffield's Main Survey Questionnaire [Between September 2026 and March 2027]: The aim is to assess the satisfaction of patients seen at the controlled structured for unscheduled care regarding their care journey and treatment using an adapted version of the University of Sheffield's Main Survey Questionnaire (MSQ). Patient satisfaction: overall satisfaction measured by a composite score derived from the MSQ, with each item (response time, wait time, staff attitude, overall satisfaction) assessed using Likert scales.
• Reported care pathways of patients not treated by the Controlled Structure for Urgent Care : calls to a Health Care Access Service [Between September 2026 and March 2027]: Description of the reported care pathways of patients if not treated by the Controlled Structure for Urgent Care (calls to a Health Care Access Service, visits to an unscheduled care center, visits to the emergency department, visits to the MMG, or refusal of care). Quantitative
• Reported care pathways of patients not treated by the Controlled Structure for Urgent Care : visits to an unscheduled care center [Between September 2026 and March 2027]: Description of the reported care pathways of patients if not treated by the Controlled Structure for Urgent Care (calls to a Health Care Access Service, visits to an unscheduled care center, visits to the emergency department, visits to the MMG, or refusal of care). Quantitative
• Reported care pathways of patients not treated by the Controlled Structure for Urgent Care : visits to the emergency department [Between September 2026 and March 2027]: Description of the reported care pathways of patients if not treated by the Controlled Structure for Urgent Care (calls to a Health Care Access Service, visits to an unscheduled care center, visits to the emergency department, visits to the MMG, or refusal of care). Quantitative
• Reported care pathways of patients not treated by the Controlled Structure for Urgent Care : visits to the on-call Medical Center [Between September 2026 and March 2027]: Description of the reported care pathways of patients if not treated by the Controlled Structure for Urgent Care (calls to a Health Care Access Service, visits to an unscheduled care center, visits to the emergency department, visits to the MMG, or refusal of care). Quantitative
• Reported care pathways of patients not treated by the Controlled Structure for Urgent Care : Refusal of care [Between September 2026 and March 2027]: Description of the reported care pathways of patients if not treated by the Controlled Structure for Urgent Care (calls to a Health Care Access Service, visits to an unscheduled care center, visits to the emergency department, visits to the MMG, or refusal of care). Quantitative
• Cost of general practice visits for patients admitted for unscheduled care from the healthcare system's perspective [One day]: The economic impact of the Controlled Structure for Urgent Care will be assessed from the perspective of the healthcare system through a cost-minimization study over a 1-day time horizon.
• Cost of visits to the emergency department avoided for patients admitted for unscheduled care from the healthcare system's perspective [One day]: The economic impact of the Controlled Structure for Urgent Care will be assessed from the perspective of the healthcare system through a cost-minimization study over a 1-day time horizon.
• Cost of visits to the on-call medical center avoided for patients admitted for unscheduled care from the healthcare system's perspective [One day]: The economic impact of the Controlled Structure for Urgent Care will be assessed from the perspective of the healthcare system through a cost-minimization study over a 1-day time horizon.
• Cost of visits to unscheduled care centers avoided for patients admitted for unscheduled care from the healthcare system's perspective [One day]: The economic impact of the Controlled Structure for Urgent Care will be assessed from the perspective of the healthcare system through a cost-minimization study over a 1-day time horizon.
• Economic viability of the programme assessed from the perspective of the La Source Primary Care Center : Amount paid for on-site nursing shifts [Between September 2026 and December 2026]: The economic viability of the program will be assessed from the perspective of the La Source Primary Care Center: * Amount paid for on-site nursing shifts * Number of unscheduled care-type consultations conducted and rates applied.
• Economic viability of the programme assessed from the perspective of the La Source Primary Care Center : Number of unscheduled care-type consultations [Between September 2026 and December 2026]: The economic viability of the program will be assessed from the perspective of the La Source Primary Care Center: * Amount paid for on-site nursing shifts * Number of unscheduled care-type consultations conducted and rates applied.

Sex: All

Inclusion Criteria:

* Any patient, whether minor or adult, who comes to the La Source Urgent Care Center to request unscheduled care. Note that patients who have a request for unscheduled care and who present at La Source Urgent Care Center but who are "outside the target population" will not be seen at the coordinated Structure for Unscheduled care but will still be included in the study, and their proportion will be reported.

Exclusion Criteria:

* None