In Paris, two multi-professional health centers, Mathagon at 18e arrondissement and Pyrénées-Belleville in the 20the, joined in 2022, as well as 24 other structures across France, the so-called “SECPA” experiment, for participatory collective exercise structures. This ambitious project funds human time to promote community health. While the generalization of SECPA is theoretically planned from 2025, we spoke to experts and users of MSP Pyrénées-Belleville, to understand how they adopted the system.
” Applying for the SECPA competition, we did not know to what extent this experiment would damage the health center, our work, our organization. » says Marie Karsenty, who alternates between reception, medical secretarial and coordination at the Paris Multiprofessional Health Center (MSP) in Pyrénées-Belleville. The observation is the same for caregivers: ” I didn’t realize the extent of this experiment at the time, but our lives changed. », confirms Mady Denantes, a general practitioner associated with MSP. In less than two years, the workforce increased from 1.5 to 8 employees, who were joined by 7 doctors, 4 nurses, and an intern, extern, interns and facility maintainers. In September 2023, the structure had to be moved.
In accordance with the specifications of the experiment, recruitment included 1 additional intake and medical secretarial support person, 1 psychologist, 3 health mediators and 1 participatory health coordinator, all part-time. MSP welcomed an active queue of 5,000 patients last year, which is now growing with the possibility of receiving new patients.
A more global health approach
” We have always thought about ways to fight against social inequalities in health and we believe that it is necessary to give more to those who need more », recalls Dr. Denantes. At the front desk, Marie Karsenty, who is now assisted by another member of staff, emphasizes the vulnerability of MSP patients, some of whom need more individualized support – for example, a reminder before an appointment. She is delighted to be able to improve customer reception, a welcome she considers already part of care.
New human resources actually made it possible to establish actions that were difficult to maintain due to lack of time and resources, as they often relied on the voluntary work of SME employees. Therefore, adapted physical activity has been improved by experiments. The manager who intervened once a week moved to two weeks, and the health mediator follows the users in a more personalized way. ” Mediators are our saviors, thanks to them we act better and faster. We are more efficient », notes Dr. Denantes. These same mediators also organize a Health cafe once a month for users who need to talk in a friendly context. So many community health projects, focused on the users, but also co-built with them.
Promote user integration
Working for, with, together, this is clearly the whole point of the participatory approach supported by the SECPA experiment. Therefore, it is already planned that the guests of future MSP Health cafés will soon themselves propose the topics to be discussed. Furthermore, one of the reasons why the MSP Pyrénées-Belleville would be included in the experiment could be that it has already established a user council for several years. ” Very early on, we intuitively realized that involving the user in our activities is crucial, even if the caregivers are not used to such an operation. Together, we set up, little by little, new activities, new models », notes Dr. Denantes. Users share this observation as Pascale, a member of the User Council states: “ MSP doctors are not just medical technicians, they are human technicians “. Resolutely focused on the needs of the tenants, François, also a member of the Council of Users, appreciates that this position allows him to better understand the problems in his neighborhood and to work together with MSP to help those in need, as was the case . to oppose the exclusion of one of their senior citizens. By statute, they are members of the MSP association, but for now they do not have the right to vote. . ” If we were invited to CA I might have liked it but in a simple advisory role as the health team is fantastic. They know what they are doing and there is no question of me replacing any of them », declares Claire, a member of the user council.
Inevitable consequences
The increase in the number of employees forced SMEs to find new premises. However, the SECPA experiment only funds human time – not land or equipment – in the Paris context of high real estate tensions, this aspect could have slowed the team down. Opportunity: premises large enough and ideally located in the neighborhood became available although the city of Paris, the region and the regional health agency subsidized this change of address. In addition, this increase in staff has required private healthcare providers affiliated with MSP to manage HR issues, which they are not specifically trained for, nor are they necessarily comfortable with. So many adjustments that the Interministerial Delegation for the Prevention and Combating of Poverty (DIPLP), which is piloting the experiment with the General Administration of Health Care (DGOS), has already identified and may be taken into account when the experiment is generalized in 2025.
In the immediate future, at MSP Pyrénées-Belleville, we remain positive, hoping that the budget level will remain ambitious when the SECPA becomes common law and that all recruitments will take place.