Abstract
Background: Over the past fifteen years, integrated care policies have expanded significantly in France. One of these initiatives is the IPEP pilot programme, aimed at enhancing coordination between outpatient services and hospitals. This presentation provides an analysis of the local implementation of this programme through a qualitative research study.
Approach: This study draws on an evaluative sociological approach, utilising qualitative methodology. Approximately fifty semi-structured interviews were conducted, offering insights into the experiences and practices of health professionals at the local level. The IPEP programme, overseen by the Ministry of Health and the National Health Insurance, follows a co-constructive approach that actively involves health professionals in its design and implementation through regular consultations.
Results: The IPEP programme, implemented between 2019 and 2024, encompassed 29 groups of health professionals. Its main objective was to encourage stronger coordination between outpatient services and hospitals, primarily through performance-based payment systems. At the local level, the programme reflects broader trends in the reorganisation of primary care in France, promoting the development of integrated care models led by health professionals committed to collaborating with public authorities and reshaping primary care delivery.
The programme facilitated two significant changes. First, it fostered improved coordination among primary care professionals, leading to shifts in professional boundaries. For example, IPEP provided funding for the employment of primary care nurses—traditionally limited to private practice in France—who have taken on new responsibilities such as coordination, prevention, patient education, and administrative support, all of which contribute to enhanced patient care. However, this shift has encountered resistance from general practitioners, who are keen to maintain their central role in patient care pathway management.
Second, IPEP aimed to encourage greater coordination with hospitals. In some cases, IPEP has led to the development of coordination protocols, improved communication, more effective management of hospital admissions and discharges, and enhanced urgent care services within the community. However, the degree of success in these areas varies significantly across organisations, with some primary care groups struggling to establish collaborations with hospitals. Success in hospital coordination often depends on local dynamics, such as hybrid professional trajectories (e.g., general practitioners working part-time in both hospital and primary care settings), rather than being solely driven by the IPEP programme itself.
Implications: This research highlights the conditions that facilitate the development of integrated care between outpatient services and hospitals in France, as well as the challenges encountered. It provides valuable insights for policymakers and healthcare professionals. Furthermore, the findings have broader applicability, illustrating the importance of addressing professional boundaries and organisational hurdles in the implementation of integrated care.