How seeing a GP (or rather not) for some issues is changing in France

The legislation aims to make it easier for patients to access certain health professionals without having to get a referral from their doctor first

The Rist law is intended to make it easier for patients to see physiotherapists and chiropodists without going through a GP first
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Article published May 11, 2023

Access to healthcare in France is set to change after the adoption of a new healthcare law (loi Rist) on Wednesday (May 10).

The legislation – named after Stéphanie Rist, the MP who proposed it – aims to make certain health professionals more accessible to the public and reduce bottlenecks in GP surgeries.

It targets extending a “principle of collective responsibility” when it comes to continuing and ensuring long-term patient care. The government’s goal is to guarantee access to care for patients during non-working hours, during closures, or amid a lack of GPs.

It has already faced criticism for some of the changes it makes to workers’ pay and conditions, especially when it comes to locum hospital doctors. However, the new rules on access to specialists are intended to offer positive benefits to patients.

Read more: How a new law is causing problems at France’s under-pressure hospitals

The main changes to be aware of include:

Improved access to nurses

For certain chronic conditions, it will now be possible in some cases to see an infirmier en pratique avancée (IPA, advanced practice nurse) without first going through a GP. This will include access to physiotherapists and orthopaedists.

IPAs were introduced in 2018. They must train at university for two years to qualify.

"There are only 1,700 of us, so we’re not going to revolutionise the health system,” said Julie Devictor, president of the National Professional Council of Nurses, on the specialised information site

“However, this gives us prospects for greater intervention by nurses in the fields of prevention, screening, and health promotion.”

The scope of this change has been reduced, however, after a backlash from GPs. Direct access will now only be possible through existing healthcare structures, in partnership with GPs.

Most of the nurses and healthcare practitioners who are part of the communautés professionnelles territoriales de santé (CPTS) scheme (which covers around half of the country) will not be part of the new rules, in contrast to MPs’ original plans.

However, CPTS inclusion will be trialled, for practitioners such as speech therapists, in six departments (including two overseas).

Read also: A decade before France has more doctors, admits health minister

Read also: The cost of seeing a doctor in France is set to increase

Orthopaedic soles on prescription

The new law will also enable chiropodists to prescribe orthotic insoles. Currently, these are only available via a GP referral, but the profession has long called for easier access.

Eric Prou, president of chiropodists' professional body l'ordre des pédicures-podologues, said: “When we realise that the patient needs orthopaedic inserts, we have to send them back to the doctor. It’s a waste of time and medical time lost for the doctor."

He added: "Often, GPs will prescribe assessment, podiatric diagnosis, and insoles if necessary. This means that the doctor does not know. They need the chiropodist to know if the patient needs orthopaedic inserts. They leave it to us because they know we have diagnostic skills.”

The new law will also allow chiropodists to examine diabetic patients (who typically need regular foot care), and decide themselves which patients are most at risk, and how many preventative sessions are needed.

Chiropodists and foot care specialists will be able to adapt existing medical prescriptions for insoles and other orthopaedic devices that are “less than three years old”.

Access to physiotherapists

Patients will also have, in theory, easier access to independent physiotherapists who work via existing healthcare practices. People will not have to see their GP to be prescribed sessions.

However, Sébastien Guérard, president of the Fédération française des masseurs kinésithérapeutes rééducateurs (FFMKR), has criticised the change, and said that only 3% of physiotherapists practice in health clinics.

He said: “This bill will have a cosmetic effect only.”

Yet, Guillaume Rail, president of the Syndicat National des Masseurs-kinésithérapeutes, was in favour of the plans, as it will cut out needless waiting between seeing the GP and the physio. He said: “One of the keys to the success of physiotherapy is how early you intervene.”

Read also: The end of prescription rules for physiotherapist sessions in France?

Access to nurses for small wounds

The law states that nurses can “take charge of the prevention and treatment of wounds, including the prescription of complementary examinations and health products" in coordination, and subject to, the completion of a "training dedicated to wounds and healing".

More pharmacist care

The law has been welcomed by pharmacists, as it extends more authority to them when it comes to renewing prescriptions for chronic illnesses and administering vaccinations.

Pharmacists will be able to renew expired prescriptions up to three times, for a month each time, for the continued treatment of a chronic illness, before the patient needs to return to the GP.

This is intended to allow treatment to continue without the possible interruption that could come due to waiting for a GP appointment. Pharmacists working in labs will also be authorised to perform smear tests to check for any early cervical cancer risks.

This is also set to extend to rapid tests for other conditions, including bacterial angina (bacterial throat infection) and cystitis.

Extension of dental care

Dental assistants who have achieved the ‘level 2’ qualification will be empowered to help dental surgeons with more tasks, to free up the surgeons’ time for more complex work.

Read more: What is being done about dentist shortages in France?

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