Intégrer les ressources sanitaires libérales dans la gestion des crises sanitaires

The difficulties in integrating non-hospital health resources, identified during the first phase of the SARS-CoV-2 pandemic in spring 2020, on the one hand, and the expectations expressed by private doctors justified continuing the analysis of the management of the following epidemic rebounds and the evolution of response methods with a triple objective of identifying the brakes and levers to the integration of extra-hospital resources, evaluating the relevance of the proposals made during this initial experience feedback and to submit avenues for development to debate. If the conditions of the liberal exercise induce a strong local or territorial anchoring, and, as a corollary, seem hardly compatible with a commitment in a national health reserve, the local initiatives appearing during this pandemic testify to opportunities to organize a reinforcement territorial health, relating to the articulation or integration of these non-hospital health professionals according to their discipline, specialty, and volunteering. Such an organization, called to be fully integrated into the emergency plans and systems, supposes regulatory and operational anticipation, covering at the same time the status, the remuneration, the training, the practical and theoretical maintenance of all the actors concerned from the same territory. The place “on the front line” of doctors (in particular general practitioners) and other liberal health professionals in the detection of weak signals and the maintenance of the offer of care and the reinforcement of the capacities in particular in terms of competences that these extrahospital health resources can bring, motivate the organizational model submitted here to the debate, resulting from feedback from the field on the occasion of this pandemic which will have shaken our health system in all its dimensions and today questions our collective ability to draw lessons for the to come up.