The End of DPC (Continuing Professional Development): Myth or Reality in the Landscape of Continuing Education for Healthcare Professionals?
The question of the "end of CPD" (Continuing Professional Development) is stirring up the healthcare world following the IGAS report. While CPD has been in place since 2009, its effectiveness and suitability to the needs of healthcare professionals are regularly questioned. The introduction of the CP, initially planned for the medical professions but extended to seven regulated professions, has raised questions about the sustainability of CPD as it exists today. This article proposes to explore in depth the elements that fuel the question "end of CPD", based on information from official reports and reflections on the future of continuing education in the French healthcare sector.
Current CPD: a system at a crossroads and its weaknesses
Continuous Professional Development (CPD) was established to maintain knowledge and improve the professional skills of the twenty-eight health professions defined by the Public Health Code. Managed since 2016 by the Agence Nationale du DPC (ANDPC), a Groupement d'Intérêt Public (GIP) made up of the State and health insurance, the DPC's mission is to finance the training of liberal professionals and employees of health centers, i.e. approximately 453,800 people.
However, despite its ambition, the DPC faces significant criticism and has not fully achieved its objectives. A major finding is the low number of practitioners who have complied with their DPC obligation. During the period 2020-2022, only 5% of professionals subject to this obligation complied with it. This alarming figure highlights the difficulties encountered by the system.
Several factors explain these disappointing results. The Agence Nationale du DPC is criticized for having a too restrictive interpretation of the texts, only recognizing actions falling under priority orientations. These orientations, although framed by article L.4021-2 of the public health code, often do not meet the needs expressed by professionals. In addition, the delegation given to the Agency to arbitrate these priority orientations is considered non-compliant with article R.4021-4 CSP, which entrusts the drafting to the State for public health orientations and to the National Professional Councils (CNP) for the specific needs of each profession.
The high number of priority orientations, deemed excessive by the Court of Auditors (238 for the three-year period 2020-2022 and then 205 for 2023-2025), also contributes to the complexity and lack of clarity of the system. Many orientations have generated little or no support from professionals.
Furthermore, the evaluation of CPD activities by independent scientific committees (ISC), although provided for by Article R.4021-13 of the Public Health Code, only concerns a small proportion of the activities offered due to the congestion of certain ISCs. This situation leads to a limited a priori control of the quality of activities. Paradoxically, the proportion of activities published by hospitals and universities, potentially closer to competence needs, is decreasing in favor of commercial organizations, perhaps better equipped to meet the administrative criteria of the Agency.
Finally, salaried employees are virtually absent from CPD, particularly in healthcare establishments, which are sometimes unaware of the obligation. Difficulties in obtaining agreements between ANDPC and the Association Nationale pour la Formation Permanente des Personnels Hospitaliers (ANFH), as well as the OPCO Santé, contribute to this low penetration. Some professions are also faced with a shortage of CPD offerings, particularly in terms of professional practice assessments (EPP), to meet their specific needs.
The Emergence of Periodic Certification (CP): A New Paradigm?
Faced with the limitations of CPD, the ordinance of July 21, 2021, implemented a new obligation: periodic certification (PC). Initially introduced for medical professions under the National Council of the Order of Physicians, it has been extended to the seven professional orders, representing approximately 1,125,000 professionals out of a total of 1,965,000 health professionals subject to a skills maintenance obligation.
The CP covers three areas: continuing education, patient relations, and the health of the healthcare professional. It is part of a broader approach than the DPC, aiming to certify a professional over a cycle of six years (nine years for professionals already in practice on 01/01/2023, then back to six years), based on at least two actions planned in each of the four blocks (maintaining knowledge, improving practices, relations with patients, health of the professional), i.e. a minimum of eight actions.
The spirit of the CP (Professional Certification) is to position itself as a support tool for healthcare professionals rather than a control mechanism. The actions to achieve certification are much broader than those of the DPC (Continuing Professional Development). They consist of recognizing routine actions that do not necessarily involve the intervention of dedicated and funded organizations. Examples include risk management actions, quality and safety improvement of care, evaluation of professional practices, improvement of relations with patients, or actions related to the health of the professional. The CP also takes into account all actions carried out under the obligation of DPC, training actions outside DPC, congresses, symposia, teaching activities, research or participation in juries.
A central element of the CP is the role of the National Professional Councils (CNP). They play a decisive role in defining periodic certification standards. Although the texts do not clearly specify who is responsible for writing them, the decree issued by the Minister of Health establishing the reference system requires the opinion of the competent CNP. In practice, it is the CNP that proposes and drafts these standards. The HAS has drawn up a methodological guide to assist the CNPs in this task.
The control of compliance with the CPD obligation and the implementation of sanctions in case of non-compliance are the responsibility of the professional orders. They must have the necessary individual information to positively or negatively assess each professional. The draft decree relating to the "My Certif Pro Health" individual account provides for this information to be made available to the orders and the CNP. In the event of non-validation of CPD, an ordinal sanction is foreseen. In addition, the resumption of activity may be conditional upon the competent order carrying out actions defined in the CPD reference frameworks.
The IGAS recommendations: towards the elimination of DPC for certain professions?
In a context marked by the difficulties of the DPC and the implementation of the CP, the Minister of Health requested a new mission from the General Inspectorate of Social Affairs (IGAS) in November 2023. The objective of this mission was to examine the future of the ANDPC and the articulation between the DPC and the CP.
The IGAS report, published in December 2024, formulates several major recommendations regarding the future of skills maintenance and improvement schemes. One of the priority recommendations is the abolition of the CPD obligation for regulated professions. The mission considers that the scope of periodic certification (maintenance of skills and improvement of practices) covers the scope of CPD for these professions.
However, the report recommends maintaining the DPC obligation for professions without an order. The mission notes that the current scope of DPC actions offered to these professions is too narrow to allow them to fulfill their obligation. It therefore proposes to maintain a DPC obligation by adapting the content, in particular by removing the current system of priority orientations, deemed too numerous and far removed from the needs of professionals. The CNPs would be invited to develop DPC reference frameworks adapted to their needs. In addition, it is considered necessary to broaden the scope of DPC for these professions.
To ensure overall consistency, the report recommends aligning the durations of periodic certification, continuing professional development (CPD), and accreditation cycles for high-risk specialties to a six-year period.
Regarding funding, the mission estimates that the amount allocated in 2023 to continuing education, EPP, and GDR actions for regulated professions (approximately €438 million) could be reallocated to the CP. The analysis of the average costs of actions and CP reference projects suggests that the existing funding could cover between 3 and 4 paid actions out of the 8 mandatory ones over six years for regulated professions. Taking into account non-paid actions would complete the 8 required actions.
To ensure financial sustainability, the report emphasizes the need to revise the rules applied to the funding of CPD activities, in particular by harmonizing the accounting rules and limiting the unit cost of paid activities. The implementation of an individual financial drawing right over six years for each healthcare professional to finance paid activities is also recommended.
Finally, the mission stresses the need to introduce a posteriori evaluation for CPD and CP, with the definition of sufficiently precise ethical and scientific guidelines.
Implications and consequences of a potential end to Continuing Professional Development
The removal of the DPC (Continuing Professional Development) obligation for regulated professions, if implemented, would have significant implications for the professionals concerned and for the continuing education landscape.
For regulated professions, periodic certification would become the central mechanism for maintaining and improving skills. They would have to commit to the four blocks of the CP and carry out at least eight actions over six years. The valorization of unpaid actions, such as participation in multidisciplinary meetings, the development of structured reports or the monitoring of quality-safety indicators, would take on a more important place. The individual account "Ma Certif Pro Santé" would play a key role in monitoring the actions carried out, whether paid or unpaid. The professional orders would see their role strengthened in the control and sanction of the CP obligation.
For unregulated professions, DPC would be maintained but adapted. The removal of priority orientations and the increased involvement of CNPs in the definition of reference frameworks should make it possible to better meet their specific needs. An expansion of the scope of DPC is envisaged, as well as the development of the EPP offer. The implementation of a label common to the various DPC funders is also desired.
At the level of funding, the reallocation of funds dedicated to the Continuing Professional Development (CPD) of regulated professions to the Skills Council (CP) would require rigorous management and harmonization of funding rules. The concept of individual financial drawing rights could change access to funding for paid activities.
The transformation of the ANDPC (Agence Nationale du Développement Professionnel Continu) is also a potential consequence. The IGAS (Inspection Générale des Affaires Sociales) report envisions three scenarios: its transformation into a public institution, the transfer of its resources and competencies to a department attached to the Minister of Health, or the transfer of competencies to the HAS (Haute Autorité de Santé). The scenario favored by the mission is the transfer of competencies to the HAS.
Finally, it is crucial to emphasize that the removal of the DPC obligation for regulated professions would require a legislative provision. The recommendations of the IGAS report should therefore be taken into account by the public authorities for a possible regulatory change.
The future of continuing education: integration or coexistence of DPC and CP?
The future of continuing education for healthcare professionals appears to be heading towards a profound reconfiguration of existing systems. The coexistence of DPC and CP, with distinct objectives and modalities depending on the profession, could be a transitional phase before a more thorough integration.
The IGAS report highlights the need for a new unified organizational scheme for CP and CPD. The transfer of ANDPC's competencies to the HAS is presented as the preferred scenario. The HAS would then play a leading role in defining orientations, evaluating reference frameworks and actions, in conjunction with the CNPs. A specialized commission of the HAS, integrating the current CNCP, could be created to pilot CP and CPD.
Streamlining devices is a priority, with the removal of the mandatory Continuing Professional Development (CPD) for regulated professions and its adapted maintenance for others. Harmonizing cycle lengths and funding rules is also essential.
The "My Certif Pro Health" individual account is set to become a central tool for managing Continuing Professional Development (CPD) activities and potentially Continuous Development Program (CDP). Its development must take into account the strategic evolutions and recommendations of the IGAS mission. The DGOS (Directorate General for Healthcare Provision) is identified as the strategic pilot of this transformation, in conjunction with the ANS (Digital Health Agency) as the operational pilot. A new set of specifications for the individual account will need to be established.
Broad and constant communication with healthcare professionals is essential to support these changes and ensure that the new systems are properly understood.
Lastly, an assessment of the impact of these systems on patient health and patient health is crucial, given the scale of public spending on continuing education.
Conclusion: Navigating the future of continuing education for healthcare professionals
The end of the DPC does not necessarily mean the total disappearance of the concept of continuing professional development, but rather a significant evolution of the landscape of continuing education for healthcare professionals in France. The emergence of periodic certification for regulated professions, combined with the observed limitations of the current DPC, paves the way for a reconfiguration of the systems.
The IGAS recommendations in favor of eliminating the obligation of DPC for regulated professions and adapting it for other professions mark a potential break with the current system. The increased role of the CNP and professional orders, the valorization of non-paying actions, and the implementation of an individual account are key elements of this transformation.
While the end of CPD as we know it seems to be in sight for some professions, it is part of a drive to create a more coherent system, better adapted to the needs of professionals, and potentially more effective in terms of improving practices and the quality of care. The future of continuing training is likely to involve the gradual integration of CPD and CP, under a potentially unified governance structure centered around the HAS. The next few years will be crucial in implementing these changes and defining the future of continuing education for healthcare professionals.
