Five Primary care teams facing the Covid Pandemic: analysis of territorial mobilizations

This article offers a spatialized reading of the COVID 19 pandemic by analysing its management by five primary care teams organized in multi-professional health homes (MSPs) in two regions, the pays de la Loire and Brittany. Based on the exploitation of intermediate results of a research program (Concert-MSP) that studies the forms and modalities of multi-professional consultation in MSPs, the analysis combines two territorial dimensions: the local territories in which MSP teams have adapted to the unprecedented situation and the regional territories that have been the spaces for the deployment of health security measures decided by the State.The results show the diversity of territorial contexts (territories with a rural, intermediate or urban trend) of the 5 MSPs studied that have resulted in varied operating situations seen as combination of territorial factors more or less favourable to the proposed coordinated exercise (focus on maintaining a local care offer, focus on professionals cooperation, focus on community). Using these categories, the article analysis the management of the health crisis in primary care, by taking the regional territory as a space for the implementation of a national plan.Two different approaches are observed to mobilizing local actors and developing necessary compromises to be made locally to establish state authority. Basically, the regional health agency in Pays de la Loire favoured an approach where patients suspected of COVID-19 infection were referred to dedicated places, separated from the usual places of care, to provide medical consultations and, in a second stage, diagnostic tests. The Brittany agency, for its part, has deployed an approach based on existing organizations after listing them, and carried out follow-up work. Medical teams have set up new organizations in relation with these differentiated regional strategies but also in relation with local specificities. The analysis of the activities of health professionals within the framework of MSPs mobilizes a new definition of the notion of territory, of a sociological nature. This is professional territory, in which each professional group works to define a specific perimeter of intervention bounded by borders that sometimes impede cooperation (Schweyer, 2004). The Covid crisis has shaken up these territories by renewing the issue of patient care. Within each team, a double question arose: who supports what? With whom? Indeed, MSPs teams have changed their care