Access to physiotherapists, nurses, and opticians now easier in France

People in France will soon be able to access care from physiotherapists, nurses, and opticians more easily, in a bid to facilitate healthcare - especially in areas that lack doctors.

The new access rules were confirmed on June 28 with three decrees in the Journal Officiel. They will come into force from August 29 (two months after the decrees’ publication).

Patients with an official long-term condition (affection longue durée, ALD) will be able to see a nurse without a GP prescription, physiotherapists will be able to see a patient for eight weeks without a GP prescription, while opticians will be able to adapt some existing prescriptions without the patient having to see a specialist again.

The rules come amid multiple government measures to make access to healthcare easier, especially in areas where there is a lack of GPs or it is difficult to find an appointment.

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Physiotherapists

The rules will apply to physiotherapists working in hospitals, clinics, social or medico-social establishments, and/or in a multi-professional health centre, to treat patients on a direct access basis, without a medical prescription.

For a five-year trial basis, this will be permitted for: 

• A limit of eight sessions per patient if the patient has not had a prior medical diagnosis.

• No limit on the number of sessions if the patient has had a prior medical diagnosis.

There are some conditions, and the patient’s GP will still be involved in some capacity, for example:

• Physiotherapists must refer "patients to their GP or, failing that, to another doctor if a diagnosis or medical opinion is required”, the text states. 

• In addition, physiotherapists will have to write “an initial assessment and a report on the care provided” in the patient's shared medical file, and this to the patient and their GP.

The five-year trial of these rules will take place in the following 14 departments in mainland France: 

• Deux-Sèvres, Côtes d'Armor, Haute-Corse, Loiret, Mayotte, Meurthe-et-Moselle, Nord, Rhône, Seine-Maritime, Tarn, Var, Vendée, Yonne, and Yvelines.

The overseas territories of Martinique and La Réunion are also included.

You can find a list of participating physiotherapists in each of the departments on the Agence régionale de santé (ARS) website.

Read also: How can I find out which parts of France are lacking doctors? 

The Conseil national de l'ordre des masseurs-kinésithérapeutes (CNOMK, the national council of physiotherapists) has welcomed the rules. 

“It is becoming increasingly difficult to access physiotherapists without a doctor's prescription,” said the CNOMK in a statement. It has been calling for easier access for years.

"Patients who consult a physiotherapist frequently ask for an assessment, an opinion or advice on certain pathologies [already],” it said. “Setting up this trial means enshrining in law what 106,000 physiotherapists have always been doing in practice.”

Read also: Make sense of… Physiotherapists (kiné) and osteopaths in France 

Patients with long-term conditions and nurses

The decrees also aim to make it easier for patients with an officially-recognised long-term condition (affection de longue durée - ALD) to access nurse care.

In a statement, the Ministry of Health said the aim was to “strengthen the role of nurses in care pathways and promote the quality of care for patients".

The referral nurse will be responsible for: 

• Prevention work 

• Follow-up 

• Further referrals 

The nurse will work closely with the patient’s GP and usual pharmacist. 

ALD patients aged 16 or over will be able to nominate their chosen referral nurse to the state health body Assurance maladie. If the patient is under 16, a parent or guardian must agree. Patients can change their nominated nurse at any time by making a new declaration to the Assurance maladie.

Self-employed nurses have long called for this rule, but some doctors say it could offer unsafe ‘competition’ with GPs.

Another decree is expected to be published imminently, which would give advanced practice nurses the authority to write prescriptions, and authorise them to work in wound and scar care.

Read also: Chronic illnesses, language barriers and French health bureaucracy 

Opticians

The third decree states that opticians - under some conditions - will be authorised to adapt an existing ophthalmologist or orthoptist prescription when issuing corrective glasses or contact lenses.

This means that patients will not need to revisit an ophthalmologist or orthoptist in order to get new glasses or lenses.

The optician must have the written agreement of the prescriber, who will have 10 working days in which to inform the optician of his decision. After this deadline, the absence of a response will be equivalent to acceptance.