Clinical research provides an important gateway to therapeutic innovation and, in many cases, national participation in trials can facilitate the future availability of new treatments in the country concerned. Clinical research activity in general is declining in France, especially in terms of industry-led trials; the only exception being early-phase cancer trials. There is an urgent need to boost the level of French participation in major international trials, although this will require a marked improvement in recruitment performance. Although the many factors contributing to the mediocre performance of France merit discussion, the overriding necessity is to bring forward solutions for increasing the level of participation in clinical trials going forward. It is against this background that we propose these recommendations for facilitating and increasing overall enrolment. There are a number of potential ways in which improvements could be achieved, beginning with identifying eligible patients and offering them the opportunity to take part in clinical trials, either through greater engagement by healthcare professionals or the development of decentralised trials. Other opportunities include optimising territorial coverage through inter-hospital networks or clinical trials centre networks, strengthening and improving clinical trials centre organisational structures by introducing AI-driven patient pre-screening tools, and lastly reprofiling some of the roles involved in clinical research and the provision of associated training. While some of these recommendations require regulatory changes, the majority could be implemented immediately, and would provide a rapid response to this major strategic challenge.