1/ What was the situation in the areas studied in terms of coordination between primary care providers before the COVID-19 epidemic?

We had investigated in these areas before, which enabled us to learn about the dynamics of collaboration and coordination between primary care actors before the COVID-19 epidemic. There was heterogeneity between these areas in the dynamics of cooperation and coordination between actors and organizations. This was notably linked to the local configurations of actors and to the projects they have developed together; the fact that these dynamics had existed for a long time or not is also a factor. Thus, in some areas, these dynamics were initiated ten or fifteen years ago with the implementation of multiprofessional group practices. In others, the dynamics of collaboration and coordination are older, going back to the 1980s: some of the actors, who are still present today, had begun to organize primary care with a view to social medicine, or prevention and health promotion, or even with a view to keeping frail people at home.

2/ How did these dynamics evolve during the first wave of COVID-19?

During the first wave of COVID-19, there were deep changes in organizations and practices throughout the country: we all remember the strong uncertainty and suspension of routines that prevailed during March 2020. In the areas surveyed, certain observations are transversal: a first movement was to collaborate at the level of one's professional group - for example, paramedical professionals who had to close their practice overnight and who offered their services. Secondly, the diversity of areas and actors (primary care, hospitals, local authorities) leads to heterogeneity in the dynamics of coordination. For example, in some areas, hospitals have stopped coordinating with primary care providers, while in other areas, the COVID-19 epidemic has led to an increase in relations with the hospital and with local authorities. We observe that these developments always start from what already exists: the crisis does not create new dynamics. Nor does it disrupt the existing hierarchies between professionals, or between the ambulatory and hospital sectors.

3/ What key determinants of local integration of primary care has the health crisis highlighted?

Local integration is the constitution of a network of public and private actors who work to produce standards for organizing primary care in a given area. What we observe is the determining nature of this network and whether it has existed for a long time or not. Indeed, in order to deal with the epidemic, the actors relied on what they had previously built. Multiprofessional collaboration developed within the framework of multiprofessional group practices accelerated the organization of care for patients suspected of having COVID-19, with paramedical professionals, some of whom were volunteers, and salaried professionals who worked to refer patients and prevent contamination. Previous relationships have also enabled some primary care teams to work hand-in-hand with local authorities or hospital services. However, despite the importance of these relationships, certain factors such as under-resourced health care supply, combined with the high intensity of the epidemic, contributed to the suspension of pre-existing dynamics, underlining the role played by territorial inequalities in health.