so far, you could not consult a speech therapist or physiotherapist without a medical prescription. But that could well change. For good reason, the Rist bill, adopted at first reading in the Assembly in mid-January 2023, allow patients direct access to advanced practice nurses (APNs), physiotherapists and speech therapists. The only condition: practitioners must practice in coordinated care structures.
In other words, it concerns exclusively those working in hospitals, social or medico-social establishments, or in homes or health centers and primary and specialized care teams. In other words, this law would not apply to liberal practitioners.
A controversial law
This text, which aims in particular to fight against medical deserts, is not unanimous. “It would be dangerous to leave nurses in total autonomy”protests against 20 minutes Jean-Christophe Nogrette, deputy general secretary of the MG France generalist union. He fears in particular that his profession will lose its pivotal role in the care pathway.
According to doctors’ unions “the level of training in diagnostics is very unequal between the different professions.” Indeed, all denounce the appearance of a “two-speed medicine”. “We are just asking to be able to employ administrative staff who relieve us of administrative tasks. Because our job is to treat and that, we know how to do“, explains at the microphone of Europe 1 a doctor present during the demonstration of February 14, 2023. “We just ask to be able to be properly remunerated for the activity we provide”continues one of his colleagues.
Loi Rist: saving time for speech therapists
On the side of the unions of speech therapists, we see a saving of time and a decongestion of the cabinets. “Currently, when a patient has a doctor’s prescription, we are obliged to perform a speech therapist assessment”, informs Sarah Degiovani, president of the National Federation of Speech Therapists at 20 minutes.
Indeed, in an editorial published on the trade union platform, the practitioners “believe that direct access to care is part of a global project to try to facilitate access to speech therapy. 20 proposals were presented to the Minister of Health. Some have already been implemented and it is a deployment of all these actions that will allow more patients to be treated in speech therapy”they write.
Furthermore, Sarah Degiovani recalls that speech therapists are often trained by doctors and learn “which professional to refer a patient to in each situation.” “Moreover, patients with a neurodegenerative disease such as Alzheimer’s or Parkinson’s, or those who have had a stroke, have already been diagnosed by their doctor. The argument therefore no longer holds,” she said.
For now, “the Senate adopted in first reading, with modifications, the bill on February 14, 2023”, explains the government on its site vie-publique.fr. “A joint joint commission must now meet.” As a reminder, the text had been tabled by MP Stéphanie Rist and several of her colleagues on October 18, 2022. “It had been adopted at first reading, with modifications, by the National Assembly on January 19, 2023”, they continue. “The government initiated the accelerated procedure on this text on January 13, 2023.”