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Epidemic transition, sustained costs and health workforce shortage challenges have led numerous countries to strengthen primary care (PC) and implement new models of care. Faced with declining numbers of general practitioners (GPs), France has introduced medical assistants (MAs) in 2019 to guarantee access to care and maintain workforces in deprived areas. Trained to perform administrative and clinical tasks delegated by a physician, MAs are expected to optimize medical time and improve working conditions in practices. How does French model of MAs impact quality and productivity in GPs’ practices and articulate with other policies? We conducted a qualitative case study in 6 pilot practices to explore the effects of MAs’ work (interviews with 12 GPs, 6 MAs, collection of tasks performed by 6 MAs), complemented with views from public policy makers and health professional unions (9 interviews). MA was defined as a function centered on physicians’ needs, accessible both to administrative staff and nursing professions. MAs with a clinical profile performed a wider range of tasks, were more prone to perform clinical tasks and build developed interactions with patients, and seemed better fitted for chronic disease care management. Recruitment of MAs by physicians is supported with grants that decrease yearly while practice productivity is expected to rise. In general, a gain of efficiency in daily workload enabled GPs to slightly increase their productivity. However, for most GPs, it primarily helped them to maintain high workload without burning out. Although MAs with clinical background seem better suited for patients’ needs, recent figures have shown that more than half of MAs employed are former secretaries. If in-person secretaries could be endorsed with further administrative duties, MAs could hold a more clinical role in PC teams including physicians and allied health professionals. Other aspects than productivity must be taken into account in a support policy. Key messages • Regardless of productivity objectives to attain, hiring MAs can relieve physicians’ workload and stress, preventing them from burning out and guarantee access to care in deprived areas. • MA’s clinical profile could have a stronger impact on public health issues such as chronic disease care management.

For more than 10 years in France, multi-professional healthcare centers have been considered as innovative organizations, which offer attractive work conditions for health professionals and help to structure primary care. Their development is strongly supported by public policy (e.g. specific funding methods, a target of 2000 teams by 2022) and is seen as a mean to enhance preventive actions. From a public health perspective, when professionals define their collective project, preventive actions should be chosen according to their relevance (by considering local population needs), effectiveness (based on evidence) and realism (in terms of implementation). Our goal was to make an inventory of existing tools and recommendations but also to propose a framework that considers the actual practicing conditions of French primary care teams. Three methods were used: a bibliographic study, feedback from a consulting firm with a 10 years’ experience in supporting new teams in defining their multi-professional project, and interviews from experts and health professionals. Due to professional training and practice, preventive actions are less familiar to professionals when they are not integrated into individual and curative cares. Indeed, most existing recommendations are designed from a macroscopic point of view, dismissing the particularities of multi-professional private practice. Thus, we could identify 9 categories of factors likely to determine the relevance of a preventive action, including a specific context-population-team setting. Although this is an exploratory work, feedback from professionals confirms the potential positive or negative influence of these items on the implementation of an action. Our framework could be converted into a tool consisting of a list of questions to ask before primary care teams choose a preventive action to implement. Frequent assessments should be carried out and shared in order to develop empirical and reliable knowledge in this field. Key messages Despite a strong public policy to develop multi-professional health care centers in France, recommendations about preventive actions insufficiently consider specific conditions of practice. Mixing theoretical and practical perspectives, our framework could help to improve the relevance, effectiveness and realism of preventive actions considering a specific context-population-team setting.