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Drupal\node\Entity\Node {#1500 #entityTypeId: "node" #enforceIsNew: null #typedData: null #cacheContexts: [] #cacheTags: [] #cacheMaxAge: -1 #_serviceIds: [] #_entityStorages: [] #values: array:22 [ "nid" => array:1 [ "x-default" => "1377" ] "vid" => array:1 [ "x-default" => "1680" ] "type" => array:1 [ "x-default" => "actualites" ] "uuid" => array:1 [ "x-default" => "7af5efac-4464-4044-b2ca-2cf740b4c3b3" ] "langcode" => array:1 [ "x-default" => "fr" ] "revision_uid" => array:1 [ "x-default" => "1" ] "revision_timestamp" => array:1 [ "x-default" => "1639148232" ] "revision_log" => array:1 [ "x-default" => null ] "revision_default" => array:1 [ "x-default" => "1" ] "isDefaultRevision" => array:1 [ "x-default" => "1" ] "status" => array:1 [ "x-default" => "1" ] "uid" => array:1 [ "x-default" => "1262" ] "title" => array:1 [ "x-default" => "Courrier sur les indicateurs ACI" ] "created" => array:1 [ "x-default" => "1638550442" ] "changed" => array:1 [ "x-default" => "1639148232" ] "promote" => array:1 [ "x-default" => "1" ] "sticky" => array:1 [ "x-default" => "0" ] "default_langcode" => array:1 [ "x-default" => "1" ] "revision_translation_affected" => array:1 [ "x-default" => "1" ] "body" => array:1 [ "x-default" => array:1 [ 0 => array:3 [ "value" => """ <p>Voilà quelques semaines que nous sommes en difficultés sur nos indicateurs qui nous sont proposés par la CPAM du Rhône. Afin d'avancer positivement sur le dialogue de gestion, nous avons envoyé ce jour un courrier à la CPAM du Rhône. Nous voulons avancer ensemble avec vous, professionnels de santé, et c'est dans cette unique optique que nous vous portons à connaissance ce courrier qui a été validé par les professionnels référents et les membres du bureau de la CPTS. </p>\r\n \r\n <p> </p>\r\n \r\n <p>"</p>\r\n \r\n <p>Je vous écris ces quelques lignes pour exprimer mon questionnement sur les règles qui conditionnent les indicateurs qui ont été fixés. </p>\r\n \r\n <p> </p>\r\n \r\n <p>Les indicateurs nous renvoient à un contrôle de l’attendu en comparaison du prescrit qui a été établi un an auparavant. On peut donc parler d’évaluation du travail effectué durant un temps déterminé. Les taux en pourcentage choisis partent d’un principe d’être équitable entre toutes les CPTS, c’est effectivement une bonne chose. </p>\r\n \r\n <p> </p>\r\n \r\n <p>Si on retient l’évaluation comme base de mes propos, elle doit également prendre en compte chaque caractéristique, chaque particularité de celui qui est évalué. Si on transfère mon raisonnement à une personne en apprentissage, elle peut présenter des handicaps qui sont forcément pris en compte dans l’évaluation et dans la note propre à une évaluation normative. </p>\r\n \r\n <p> </p>\r\n \r\n <p>Chaque CPTS a ses particularités, ses handicaps et chaque communauté doit s’adapter au terrain en prenant en compte les spécificités, les forces et les faiblesses du monde médico-sociales. Le législateur a créé des communautés qui prennent en compte tous les paramètres locaux pour s’adapter au plus juste et au réalisable. Les handicaps de chacun ont voulu être pris en compte dès la conception des CPTS.</p>\r\n \r\n <p> </p>\r\n \r\n <p>Fixer une évaluation normée par pourcentage ne permet pas de prendre compte les particularités de chaque CPTS.</p>\r\n \r\n <p>Pour illustrer mes propos, prenons l’exemple des soins non programmés. Demander à une CPTS de taille 4 d’inclure 80 % des médecins généralistes représentant 142 médecins dans un territoire meurtri par la désertification médicale est utopique et contreproductif.</p>\r\n \r\n <p>Outre le problème interne de la gestion et la réservation des créneaux, c’est la rémunération de ces 142 médecins qui va également nous handicaper davantage. </p>\r\n \r\n <p> </p>\r\n \r\n <p>Nous devions pour l’année 2020 avoir fait 1000 rendez-vous programmés. C’était un handicap de taille, car la finalité de l’objectif était impossible alors que nous étions les seuls à avoir débuté ce parcours. </p>\r\n \r\n <p> </p>\r\n \r\n <p>Enfin, preuve de l’évaluation normative et sanctionnant, notre document de travail que vous nous avez remis est étiqueté « CPTS du mont du Lyonnais ». </p>\r\n \r\n <p>Si je comprends bien que votre travail doit également être uniformisé dans un service « de soins du premier recours » en plein développement à la CPAM du Rhône et force d’accompagnement au quotidien, il est à mon sens important de tenir compte de la réalité du terrain et des forces vives qui donnent de l’investissement et beaucoup de temps personnel. </p>\r\n \r\n <p> </p>\r\n \r\n <p>C’est avec mes propos que je vous propose d’échanger de vive voix pour que nous puissions engager un dialogue constructif avec les professionnels de santé de Beaujolais Dombes pour ceux qui seront disponibles dans cette 5e vague. </p>\r\n \r\n <p> </p>\r\n \r\n <p>Très cordialement,<br />\r\n Ludovic BINDER"</p>\r\n \r\n <p> </p>\r\n \r\n <p> </p>\r\n """ "summary" => "" "format" => "full_html" ] ] ] "field_date_de_publication" => array:1 [ "x-default" => array:1 [ 0 => array:1 [ "value" => "2021-12-03" ] ] ] "field_image" => array:1 [ "x-default" => array:1 [ 0 => array:5 [ "target_id" => "557" "alt" => "Préparer sa négociation" "title" => "" "width" => "320" "height" => "360" ] ] ] ] #fields: [] #fieldDefinitions: array:25 [ "nid" => Drupal\Core\Field\BaseFieldDefinition {#1578 #definition: array:6 [ "label" => Drupal\Core\StringTranslation\TranslatableMarkup {#1579 #string: "ID" #arguments: [] #translatedMarkup: null #options: [] #stringTranslation: null } "read-only" => true "provider" => "node" "field_name" => "nid" "entity_type" => "node" "bundle" => null ] #typedDataManager: null #itemDefinition: Drupal\Core\Field\TypedData\FieldItemDataDefinition {#1580 #definition: array:2 [ "type" => "field_item:integer" "settings" => array:6 [ "unsigned" 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"revision_translation_affected" => Drupal\Core\Field\BaseFieldDefinition {#1646 #definition: array:9 [ "label" => Drupal\Core\StringTranslation\TranslatableMarkup {#1647 #string: "Revision translation affected" #arguments: [] #translatedMarkup: null #options: [] #stringTranslation: null } "description" => Drupal\Core\StringTranslation\TranslatableMarkup {#1648 #string: "Indicates if the last edit of a translation belongs to current revision." #arguments: [] #translatedMarkup: null #options: [] #stringTranslation: null } "read-only" => true "revisionable" => true "translatable" => true "provider" => "node" "field_name" => "revision_translation_affected" "entity_type" => "node" "bundle" => null ] #typedDataManager: null #itemDefinition: Drupal\Core\Field\TypedData\FieldItemDataDefinition {#1649 #definition: array:2 [ "type" => "field_item:boolean" "settings" => array:2 [ "on_label" => Drupal\Core\StringTranslation\TranslatableMarkup {#1650 #string: "On" #arguments: [] #translatedMarkup: 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"field_name" => "metatag" "bundle" => null ] #typedDataManager: null #itemDefinition: Drupal\Core\Field\TypedData\FieldItemDataDefinition {#1655 #definition: array:2 [ "type" => "field_item:metatag_computed" "settings" => [] ] #typedDataManager: null #fieldDefinition: Drupal\Core\Field\BaseFieldDefinition {#1652} } #type: "metatag_computed" #propertyDefinitions: null #schema: null #indexes: [] } "path" => Drupal\Core\Field\BaseFieldDefinition {#1656 #definition: array:8 [ "label" => Drupal\Core\StringTranslation\TranslatableMarkup {#1657 #string: "URL alias" #arguments: [] #translatedMarkup: null #options: [] #stringTranslation: null } "translatable" => true "display" => array:1 [ "form" => array:2 [ "options" => array:2 [ "type" => "path" "weight" => 30 ] "configurable" => true ] ] "computed" => true "provider" => "path" "field_name" => "path" "entity_type" => "node" "bundle" => null ] #typedDataManager: null #itemDefinition: Drupal\Core\Field\TypedData\FieldItemDataDefinition {#1658 #definition: array:2 [ "type" => "field_item:path" "settings" => [] ] #typedDataManager: null #fieldDefinition: Drupal\Core\Field\BaseFieldDefinition {#1656} } #type: "path" #propertyDefinitions: null #schema: null #indexes: [] } "menu_link" => Drupal\Core\Field\BaseFieldDefinition {#1659 #definition: array:12 [ "label" => Drupal\Core\StringTranslation\TranslatableMarkup {#1660 #string: "Menu link" #arguments: [] #translatedMarkup: null #options: [] #stringTranslation: null } "description" => Drupal\Core\StringTranslation\TranslatableMarkup {#1661 #string: "Computed menu link for the node (only available during node saving)." #arguments: [] #translatedMarkup: null #options: [] #stringTranslation: null } "revisionable" => true "class" => "\Drupal\token\MenuLinkFieldItemList" "translatable" => true "internal" => true "display" => array:2 [ "view" => array:1 [ "options" => array:2 [ "label" => "hidden" "region" => "hidden" ] ] "form" => array:1 [ "options" => array:1 [ "region" => "hidden" ] ] ] "computed" => true "provider" => "token" "field_name" => "menu_link" "entity_type" => "node" "bundle" => null ] #typedDataManager: null #itemDefinition: Drupal\Core\Field\TypedData\FieldItemDataDefinition {#1662 #definition: array:2 [ "type" => "field_item:entity_reference" "settings" => array:3 [ "target_type" => "menu_link_content" "handler" => "default" "handler_settings" => [] ] ] #typedDataManager: null #fieldDefinition: Drupal\Core\Field\BaseFieldDefinition {#1659} } #type: "entity_reference" #propertyDefinitions: null #schema: null #indexes: [] } "body" => Drupal\field\Entity\FieldConfig {#1663 #entityTypeId: "field_config" #enforceIsNew: null #typedData: null #cacheContexts: array:1 [ 0 => "languages:language_interface" ] #cacheTags: [] #cacheMaxAge: -1 #_serviceIds: [] #_entityStorages: [] #originalId: "node.actualites.body" #status: true #uuid: "24300c1b-8327-4162-84b7-e56ab19386a6" -isUninstalling: false #langcode: "fr" #third_party_settings: [] #_core: [] #trustedData: false #dependencies: array:2 [ "config" => array:2 [ 0 => "field.storage.node.body" 1 => "node.type.actualites" ] "module" => array:1 [ 0 => "text" ] ] #isSyncing: false #id: "node.actualites.body" #field_name: "body" #field_type: "text_with_summary" #entity_type: "node" #bundle: "actualites" #label: "Body" #description: "" #settings: array:2 [ "display_summary" => true "required_summary" => false ] #required: false #translatable: true #default_value: [] #default_value_callback: "" #fieldStorage: null #itemDefinition: null #constraints: [] #propertyConstraints: [] #deleted: false +original: ? Drupal\field\Entity\FieldConfig } "field_body_2" => Drupal\field\Entity\FieldConfig {#1664 #entityTypeId: "field_config" #enforceIsNew: null #typedData: null #cacheContexts: array:1 [ 0 => "languages:language_interface" ] #cacheTags: [] #cacheMaxAge: -1 #_serviceIds: [] #_entityStorages: [] #originalId: "node.actualites.field_body_2" #status: true #uuid: "9580dbb0-2dd7-4931-9925-de027674142b" -isUninstalling: false #langcode: "fr" #third_party_settings: [] #_core: [] #trustedData: false #dependencies: array:2 [ "config" => array:2 [ 0 => "field.storage.node.field_body_2" 1 => "node.type.actualites" ] "module" => array:1 [ 0 => "text" ] ] #isSyncing: false #id: "node.actualites.field_body_2" #field_name: "field_body_2" #field_type: "text_with_summary" #entity_type: "node" #bundle: "actualites" #label: "Body 2" #description: "" #settings: array:2 [ "display_summary" => false "required_summary" => false ] #required: false #translatable: false #default_value: [] #default_value_callback: "" #fieldStorage: null #itemDefinition: null #constraints: [] #propertyConstraints: [] #deleted: false +original: ? Drupal\field\Entity\FieldConfig } "field_date_de_publication" => Drupal\field\Entity\FieldConfig {#1665 #entityTypeId: "field_config" #enforceIsNew: null #typedData: null #cacheContexts: array:1 [ 0 => "languages:language_interface" ] #cacheTags: [] #cacheMaxAge: -1 #_serviceIds: [] #_entityStorages: [] #originalId: "node.actualites.field_date_de_publication" #status: true #uuid: "5f5bf9ff-5400-419b-853b-9d29e22b904f" -isUninstalling: false #langcode: "fr" #third_party_settings: [] #_core: [] #trustedData: false #dependencies: array:2 [ "config" => array:2 [ 0 => "field.storage.node.field_date_de_publication" 1 => "node.type.actualites" ] "module" => array:1 [ 0 => "datetime" ] ] #isSyncing: false #id: "node.actualites.field_date_de_publication" #field_name: "field_date_de_publication" #field_type: "datetime" #entity_type: "node" #bundle: "actualites" #label: "Date de publication" #description: "" #settings: [] #required: false #translatable: false #default_value: array:1 [ 0 => array:2 [ "default_date_type" => "now" "default_date" => "now" ] ] #default_value_callback: "" #fieldStorage: null #itemDefinition: null #constraints: [] #propertyConstraints: [] #deleted: false +original: ? Drupal\field\Entity\FieldConfig } "field_image" => Drupal\field\Entity\FieldConfig {#1666 #entityTypeId: "field_config" #enforceIsNew: null #typedData: null #cacheContexts: array:1 [ 0 => "languages:language_interface" ] #cacheTags: [] #cacheMaxAge: -1 #_serviceIds: [] #_entityStorages: [] #originalId: "node.actualites.field_image" #status: true #uuid: "8c0b49a4-fabd-4338-821a-f30394da83d6" -isUninstalling: false #langcode: "fr" #third_party_settings: [] #_core: [] #trustedData: false #dependencies: array:2 [ "config" => array:2 [ 0 => "field.storage.node.field_image" 1 => "node.type.actualites" ] "module" => array:1 [ 0 => "image" ] ] #isSyncing: false #id: "node.actualites.field_image" #field_name: "field_image" #field_type: "image" #entity_type: "node" #bundle: "actualites" #label: "Image actualité" #description: "" #settings: array:12 [ "handler" => "default:file" "handler_settings" => [] "file_directory" => "[date:custom:Y]-[date:custom:m]" "file_extensions" => "png gif jpg jpeg" "max_filesize" => "" "max_resolution" => "" "min_resolution" => "" "alt_field" => true "alt_field_required" => true "title_field" => false "title_field_required" => false "default_image" => array:5 [ "uuid" => "" "alt" => "" "title" => "" "width" => null "height" => null ] ] #required: false #translatable: true #default_value: [] #default_value_callback: "" #fieldStorage: null #itemDefinition: null #constraints: [] #propertyConstraints: [] #deleted: false +original: ? Drupal\field\Entity\FieldConfig } ] #languages: null #langcodeKey: "langcode" #defaultLangcodeKey: "default_langcode" #activeLangcode: "x-default" #enforceDefaultTranslation: null #defaultLangcode: "fr" #translations: array:1 [ "x-default" => array:1 [ "status" => 1 ] ] #translationInitialize: false #newRevision: false #isDefaultRevision: "1" #entityKeys: array:4 [ "bundle" => "actualites" "id" => "1377" "revision" => "1680" "uuid" => "7af5efac-4464-4044-b2ca-2cf740b4c3b3" ] #translatableEntityKeys: array:8 [ "label" => array:1 [ "x-default" => "Courrier sur les indicateurs ACI" ] "langcode" => array:1 [ "x-default" => "fr" ] "status" => array:1 [ "x-default" => "1" ] "published" => array:1 [ "x-default" => "1" ] "uid" => array:1 [ "x-default" => "1262" ] "owner" => array:1 [ "x-default" => "1262" ] "default_langcode" => array:1 [ "x-default" => "1" ] "revision_translation_affected" => array:1 [ "x-default" => "1" ] ] #validated: false #validationRequired: false #loadedRevisionId: "1680" #revisionTranslationAffectedKey: "revision_translation_affected" #enforceRevisionTranslationAffected: [] #isSyncing: false +in_preview: null }