Keywords: Medical desertification, rural medicine, CPTS (Territorial Professional Health Communities), access to healthcare, medical demographics, Indre, Centre-Val de Loire, crisis management, primary care

Background:

The Centre-Val de Loire region is experiencing a medical demographic crisis. Its density of general practitioners is the lowest in France (101.6 practitioners per 100,000 inhabitants, compared to 125.6 nationally). The Indre department is particularly affected, with 97% of municipalities classified as sparsely populated, rural, and very low-density. Between 2010 and 2024, the density of general practitioners decreased by 32.7% (from 120.3 to 80.9 doctors per 100,000 inhabitants), while the population of people over 60 increased by 11.2%. The department is the 6th least equipped in France in terms of general practitioners, with 44.2% aged over 60, which suggests a worsening of the situation.

Aim of the study:

To assess the influence of Territorial Health Professional Communities (CPTS) as a response to the healthcare access crisis in rural areas of Indre.

Methodology:

The study is based on the analysis of the medical demographic situation in Indre and the deployment of the six CPTS in the department. It examines local initiatives such as the medical bus project or the strengthening of the "Access to Care Service". It also evaluates the evolution of professional practices toward a "treating circle" model.

Results:

Despite the deployment of CPTS, their effectiveness remains limited by a shortage of 29 general practitioners (19% of the region's needs). Healthcare organization is evolving toward a "treating circle" system, characterized by an increasing delegation of tasks and a degraded level of care. Palliative initiatives are framed within a crisis management logic rather than a structural reform approach.

Conclusions:

Indre illustrates the challenges of rural medicine in "survival mode." Without a restructuring of healthcare organization and practice models, access to primary care will remain unequal and precarious. Current measures, although necessary, are insufficient in addressing the scale of the crisis. A sustainable response requires comprehensive strategies to transform healthcare provision in rural areas in the long term.