New law ‘will improve access to healthcare’ in France

MPs in France recently approved a bill which will allow patients to see certain nurses and specialists without being referred by a GP

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Health professionals have welcomed a new law that will allow patients to see certain nurses and specialists without having to visit a GP first.

They say it will save time and improve care. The Loi Rist, passed by MPs in May, will, for example, allow certain patients direct access to an infirmier en pratique avancée (IPA, advanced practice nurse).

Julie Devictor, president of the Conseil National Professionnel des Infirmiers en Pratique Avancée (CNP IPA), said: “It’s very good news, and something we’ve been waiting a long time for.”

The IPA role was created in 2018 to reduce doctors’ workloads and improve patient care.

IPAs are experienced nurses who have undertaken an additional two years of university study.

They offer longer consultations in addition to doctor visits, usually for patients suffering from chronic illnesses.

Ms Devictor said direct access to IPAs would particularly benefit patients in psychiatry.

‘Wait months for an appointment’

“There is a lack of psychiatrists, and patients have to wait months for an appointment.

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“If they are seen by an IPA in psychiatry for an initial assessment, the nurse can evaluate the level of urgency and potentially alert the psychiatrist.”

It will also be possible to consult a speech therapist or physiotherapist (up to eight sessions) without a GP referral.

Following disagreements between MPs and senators, however, direct access to IPAs and physiotherapists will apply only to professionals who work in existing healthcare structures, such as health centres, in partnership with GPs.

This includes just 3% of physiotherapists, according to trade unions.

It excludes those working in communautés professionnelles territoriales de santé (CPTS) – local groups of healthcare professionals who agree to work together.

An experiment into including CPTSs will take place in six departments.

This does not affect IPAs, as they are not usually permitted to work as part of a CPTS.

Patients’ group France Assos Santé welcomed the changes.

Its president Gérard Raymond said: “We have always been in favour of opening up new responsibilities to other health professionals. “That will mean working in a team, with a doctor who is responsible for the diagnosis, and then everyone working in collaboration.”

He does, however, regret the exclusion of CPTSs.

Small step, not leap forward

“We would have preferred to take a leap forward, instead of a small step. “The first issue is we do not have enough IPAs.”

There are currently just 1,400 qualified IPAs, but this number is set to rise by 700 each year.

Rules around who can give prescriptions are also due to become more flexible.

IPAs will be allowed to write prescriptions instead of just renewing them, which Ms Devictor said many nurses do already when the doctor is not available.

“The French system continually forces nurses to circumvent the law. This will put them in compliance.”

Chiropodists will be allowed to prescribe orthotic insoles, which are currently available only via a GP referral.

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 interruption due to waiting for a GP appointment.

Pharmacists working in labs will be authorised to perform smear tests to check for any early cervical cancer risks.

This will also extend to rapid tests for other conditions, including bacterial throat infections and cystitis.

Direct access to these professionals is due to take effect once the law is definitely adopted in late May, but the right for IPAs to write new prescriptions will require a decree to be published with more details, which might take several months.

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