Lawyer for health regulations and compliance

Are you a private clinic looking to pool your material resources or develop a project with a public health establishment? Our lawyers specialized in implementing hospital cooperation offer solutions that best suit your needs to structure and formalize your partnership project.

At Macfarlanes LLP, we offer the creation of specific legal structures or the drafting of adapted agreements to implement these initiatives. For each regional intervention, we analyze the issues in terms of healthcare provision in the area. To do this, our team reviews the Regional Health Project (PRS) and the Regional Healthcare Organization Plan (SROS).

Lawyer for implementing hospital cooperation through the creation of a legal structure

The implementation of hospital cooperation often relies on the creation of appropriate legal structures, such as GCS, GIE, GIP, GHT, or GCS-MS. These entities make it possible to organize and formalize relations between the establishments and professionals involved.

Groupement de coopération sanitaire (GCS)

The GCS is a legal structure set up to allow health professionals, public or private health establishments, medico-social establishments, health centers, and health homes to pool resources or manage common activities. Redefined by the Hospital, Patients, Health, Territories (HPST) law, which clarified the GCS of means and declined it in the form of GCS-Health Establishment, it aims to improve the efficiency of services offered to patients by optimizing available resources.

Indeed, when it holds one or more authorizations for healthcare activities, the cooperative hospital group is a healthcare establishment.

The legal nature of a GCS depends on its composition: it can be under public law when it is constituted exclusively by public law entities, or by public law entities and private law entities, or under private law when it is constituted exclusively by private law entities.
In other cases, its legal nature is determined by the members in the constitutive agreement.
By obligation, a GCS must include at least one healthcare establishment among its members.

The GCS may also include other healthcare professionals or organizations, subject to approval by the director of the Regional Health Agency (ARS). The legal nature of the group determines the budgetary and accounting rules applicable to its operation.

The GCS is based on a founding agreement that specifies its organization and objectives. Drawn up by its members, this agreement must be validated by the ARS. The Healthcare Cooperation Group may be established with or without share capital, but its articles of association must necessarily provide for the participation of members in operating costs.

The group has the possibility of employing staff, whether medical or non-medical. Their status depends on the legal nature of the GCS (public or private). Members may also make their own employees available, in accordance with the rules applicable to non-profit organizations. In addition, the GCS may benefit from seconded personnel to carry out its missions.

As an autonomous legal entity, it can acquire the assets and equipment necessary to achieve its objectives. Our lawyers specialized in implementing hospital cooperation assist you in drafting the bylaws and organizing the internal operating rules.

Economic Interest Grouping (EIG)

Endowed with legal personality under private law, the GIE is another option to facilitate the pooling of resources or services without requiring the creation of a separate healthcare establishment. Created by the ordinance of September 23, 1967, it allows its members, whether individuals or legal entities, to pool resources to develop their economic activities while remaining independent. Its legal framework is defined by Articles L.251-1 to L.251-3 of the Commercial Code.

The GIE aims to increase the activity of its members, without seeking to make a profit for itself. It may have a civil or commercial purpose, without its members thereby becoming merchants. It can be created with or without capital, but must have at least two members, who are jointly and severally liable for its debts, as in a general partnership (SNC).

To operate, the GIE must appoint several bodies:

• directors (individuals or legal entities);
• a management controller (obligatorily a natural person);
• an auditor.

When creating an EIG, it is essential to clearly define the role of each member in the constitutive contract, particularly regarding administration and control. The rules governing management functions, such as the terms of appointment, removal or the duration of mandates, must be specified. The corporate purpose must be strictly linked to the economic activity of the members.

With our law firm expert in health law, benefit from support in determining economic objectives and sharing legal responsibilities among members. Our lawyers specialized in implementing hospital cooperation intervene in the definition of governance bodies, the establishment of decision-making processes, and the resolution of internal conflicts.

Public Interest Group (GIP)

Inspired by the GIE, the GIP is a legal structure allowing partnerships between public entities or between public and private entities. As a public legal entity with a special status, it is governed by Law No. 2011-525 of May 17, 2011, and Decree No. 2012-91. The GIP can be used for any non-profit activity of general interest. However, a local authority cannot create a GIP, even if it took the initiative.

Developed from a model proposed by the Ministry of the Economy, the constitutive agreement of the group must be approved by the competent administrative authority:

• the prefect for local GIPs;
• or the relevant minister for national GIPs.

The accounting framework of the GIP depends on its main activity. For a public administrative service mission, public budgetary and accounting rules apply, in accordance with decree n°2012-1246 on public management. On the other hand, for industrial or commercial activities, the legal framework applicable to accounting follows private law rules, offering more flexibility.

The legal regime of GIP staff also varies depending on its activity:

• public law for a public administrative service mission, in accordance with Decree No. 2013-292;
• private law for activities oriented towards the market or competitive sector.

Our team handles the drafting of your founding agreement and its publication in the Official Journal or in a specific official administrative bulletin, depending on the geographical and sectoral scope of the GIP. Our lawyers specialized in implementing hospital cooperation assist you in obtaining the necessary authorizations and managing relations with health authorities.

Lawyer to implement hospital cooperation through the drafting of an agreement without establishing an ad hoc structure

Certain hospital cooperations do not require the creation of a dedicated legal structure such as a GIE, GIP, GCS, GHT, or a public-private health center. Our lawyers specialized in implementing hospital cooperations assist healthcare establishments in drafting agreements adapted to formalize partnerships.

Co-use agreements for optimized resource sharing

Co-use agreements allow several healthcare establishments to share equipment or infrastructure. These cooperation agreements aim for efficiency and cost reduction while maximizing the use of available resources. Each signatory healthcare establishment must clearly know its rights and obligations.

For example, in the case of sharing a technical platform or a radiology device, the terms of use (time slots, maintenance, replacement in case of breakdown) must be precisely defined. The allocation of costs related to the maintenance, operation, and upkeep of medical infrastructure or equipment is essential.

The cooperation agreements must also specify the terms of access and use to avoid any unfair competition between member institutions. Moreover, their drafting is often preceded by negotiations between the parties. Our corporate law lawyers in the healthcare sector intervene to facilitate these discussions, identify sticking points, and propose suitable solutions.