Twenty years after the introduction of the general practitioner (GP) system in France, the Court of Auditors has pointed out a surprising contradiction in its latest report, commissioned by the Social Affairs Committee of the National Assembly in July 2025. While the system covers 89 percent of the adult population, approximately 6.3 million insured individuals still lack a GP. At the same time, 8,553 private general practitioners either do not perform this role or serve only a small number of patients. The Court of Auditors argues that this untapped potential should be better utilized to improve access to ongoing medical care. The report highlights that 6.3 million French citizens lack a primary care physician, which affects their access to healthcare. Visits to a primary care physician are covered at 70% by the national health insurance, compared to only 30% for consultations with other general practitioners. Most medical specialties, except for gynecology, ophthalmology, psychiatry, and dentistry, are less reimbursed if a primary care physician is not consulted first. Despite the system being in place for two decades, the report notes that a third of the 6.3 million people without a GP have chronic illnesses or are elderly, requiring regular medical follow-up. Worse still, one in five of these individuals consults less than once a year, resulting in health prevention outcomes similar to those without a primary care physician. The Court of Auditors emphasized that the GP system can be effective if properly implemented, particularly with regular check-ups, in light of an aging population and the rise of chronic diseases. Contrary to common belief, the largest gaps in GP coverage are found in urban areas where the population is younger and doctors are less inclined to become primary care physicians. The Court noted that 15% of private general practitioners, or 8,500 doctors, do not function as primary care physicians. Instead, they often engage in more profitable areas such as aesthetic medicine or allergology. To address this, the Court suggested that these doctors be encouraged or required to take on more primary care responsibilities. The Court of Auditors also noted that the number of patients per primary care physician has increased from 919 in 2016 to 1,130 in 2024, a 23% rise over eight years. It recommended setting a minimum threshold of 500 patients per GP to increase coverage for 2.5 to 4 million more people. To enforce this, the Court suggested either penalizing doctors who refuse, such as by withdrawing funding for equipment, or increasing their salaries for those who agree to serve as primary care physicians. These doctors receive an average of 20,000 euros annually for joining the system, with an additional 6,200 euros for meeting public health targets such as vaccination rates or screening programs. Despite these recommendations, the Court of Auditors found no evidence that doctors have a financial incentive to avoid the role of a primary care physician. In fact, those who serve as primary care physicians earned more overall. In 2024, the median annual salary for private general practitioners was 166,000 euros, with those in primary care roles earning 171,000 euros, compared to only 98,000 euros for those who rarely or never fulfilled this role. However, this difference is not due to a bonus for being a primary care physician, but rather the higher volume of patients and more frequent medical acts they perform. The Court criticized the current structure of remuneration for general practitioners, noting that 81.7% of their income still comes from payment per act in 2024, despite efforts to shift toward forfaitary payments. Direct funding tied to the role of a primary care physician accounted for 11.8% of their overall earnings in 2024, up from 9.7% a decade earlier. The Court argues that general practitioners should be paid more for long-term patient follow-up, prevention, and care coordination, rather than primarily for each consultation. However, the 2024 medical convention is expected to increase payments for acts by over a billion euros by 2028, with most of that increase going to consultations, not forfaitary payments. This could push the share of payment per act even higher, from 81.7% to 83%, which the Court believes is not the desired outcome. The report includes this as one of its eight formal recommendations. While the report provides a detailed analysis of the GP system's implementation, it does not examine the financial benefits for the state or the reduction in redundant medical acts. This is a notable limitation, especially as the national health insurance system is expected to face a deficit of more than 22 billion euros in 2026, prompting the government to explore all possible cost-saving measures.