The general practioner & the coordinated care path

The role of the general practitioner

The general practitioner you choose plays a central role in your medical follow-up. He is not only the one who usually treats you, but also the one who:

  • coordinates your care and ensures that your medical follow-up is optimal,
  • will guide you in the coordinated care path: he is your privileged interlocutor, informs you and, if necessary, connects you with other health professionals (medical specialists, hospital doctors, etc.)
  • knows and manages your medical record: it centralizes all information concerning your care and your health (exam results, diagnoses, treatments, etc.) and updates them,
  • ensures personalized prevention: it helps you to prevent health risks, for example by monitoring vaccination, carrying out organized screening tests (eg breast cancer screening), help with stopping smoking or nutrition tips, depending on your lifestyle, your age or your family history.

Better informed, your doctor will advise you on the exams or treatments that best suit your health. This can help you avoid unnecessary consultations, repeat tests or dangerous mixtures of medications.

What are the benefits for you?

Consulting your general practioner brings you two advantages:

  • you are better cared for, thanks to a follow-up coordinated in the long term and adapted to your state of health by a doctor who knows you well and who manages your medical record,
  • by choosing your primary care physician and consulting it on a priority basis, the reimbursement of your consultations remains unchanged, with the current rates in effect.

On the other hand, if you do not yet have a general practioner or if you do not respect the coordinated care path, you will be less well reimbursed by your student health or social insurance fund.

By choosing to declare your general practioner and consulting it first, your usual reimbursement rate remains unchanged.

For example, a consultation with an approved general practitioner practicing in sector 1 costs 25 € (tariff applicable on 1 May 2017):

  • If this is your general practioner stated, you are in the coordinated care pathway. The Health Insurance will reimburse you 70% of the consultation fee, minus 1 € for the lump sum participation, ie a refund of 16,50 €.
  • If you do not have a general practioner, you are out of the coordinated care path. The Health Insurance will reimburse you only 30% of the consultation fee, minus 1 € for the fixed contribution, or a refund of 6.50 €.

To be sure of a medical follow-up and get a better refund, consider choosing and declaring your doctor.

Choosing or changing the general practioner?

You have the free choice of your general practioner. It can be your family doctor or another doctor, generalist or specialist, contracted or not, the essential thing is to privilege the doctor who knows you best.

There is no constraint on the choice of your general practioner. Any physician can fulfill this role, provided that he or she gives you his or her consent.

He can work alone, in a practice, in a health center or in a hospital. There are no geographical constraints, the main thing is to choose what is most convenient for you.

The general practioner, whether it is an approved sector 1 or sector 2 with a free fee, can be a general practitioner or a specialist doctor.

Attention: the declaration of the general practioner is nominative. Even in the case of physicians practicing in a group practice, you must appoint a specific physician as the general practioner. However, in particular in the absence of this designated physician, you can consult your fellow members of the group practice without penalization (respect of the care path), who can bill as a substitute physician.

You are free to change the general practioner, unconditionally to complete and without the need to justify yourself. You are also not required to inform your previous medical practitioner beforehand, but you must make a new declaration of choice of the general practioner in conjunction with the new doctor you have chosen as a general practioner.

 

How do I declare my general practioner?

Once you have chosen your treating physician, print the "Déclaration de choix du médecin traitant" (form S3704) and fill out this form.

Submit this form to our services at the following address:

SMEREP- Service GDB, 16 Boulevard du General Leclerc, 92115 CLICHY Cedex.

No need to consult your doctor specifically to make the declaration of choice of general practioner: take advantage of a future consultation or a trip to his office to perform this formality.

How can I verify that my declaration of choice from the general practioner is registered?

This information is available on your free online personal space My SMEREP.

 

The coordinated care pathway

You are on the path of coordinated care if:

- you consult your general prationer or his replacement,

- or a corresponding physician by referral from your general prationer.

In certain situations (geographical distance, emergency, vacations, etc.), you stay in the coordinated care path even if you do not consult your doctor.

On the other hand, you can consult some specialist doctors without going through your general prationer.

You consult your general prationer's replacement

- If your general prationer is unavailable, his usual substitute will use his care sheets and you will be reimbursed as normal.

- If your general prationer practices in a clinic or a health center, you may also have another physician in your practice or center. This will then check the " Médecin traitant remplacé " box on the care sheet. You will be reimbursed normally.

Note: You can not designate a substitute physician as the general prationer.

In case of displacement or emergency

If you are away from home, you can consult a doctor other than your general prationer.

This doctor then ticks the box "Hors résidence" on the care sheet. You will be reimbursed normally.

In case of emergency, you may also consult a doctor other than your general practioner. This doctor then ticks the " Urgence" box on the care sheet. You will be reimbursed normally.

To note :

A situation which is unforeseen more than 8 hours before is considered urgent and relates to a condition or suspicion of a condition involving the life of the patient or the integrity of his organism and leading to the rapid mobilization of the physician.

Care or treatment following an emergency is considered to be in the coordinated care path once your general practioner is kept informed.

You consult a physician at the request of your general practioner.

Your doctor has referred you to another general practitioner or specialist. This doctor must indicate on the care sheet the surname and first name of your general practioner.

You will normally be reimbursed according to the usual tariffs, ie 70% of the basic tariff, minus 1 euro for the fixed contribution.

You consult a gynecologist, an ophthalmologist, a psychiatrist or a stomatologist

- If you have a registered general practioner, you can consult directly:

- a gynecologist, for periodic clinical examination including screening, prescribing and monitoring contraception, pregnancy monitoring or termination of pregnancy,

- an ophthalmologist, for the prescription and renewal of corrective lenses or contact lenses, for screening and follow-up of glaucoma,

- a psychiatrist or a neuropsychiatrist if you are between 16 and 25 years of age,

- a stomatologist, except for heavy surgical procedures.

This specialist doctor will then check the box " Accès direct spécifique  " on the care sheet. You will be reimbursed normally.

Apart from these acts provided for direct access authorized, you must have been referred by your general doctor to one of these specialist doctors or you will be less well reimbursed

Special cases

You are in the coordinated care pathway if you consult directly with a specialist doctor, without going through your doctor, in the following situations:

- in the context of a protocol of care established for a long-term condition,

- if this specialist doctor is following you in a chronic illness,

- for a control consultation,

- as part of a sequence of care in consultation with your attending physician.

You will be reimbursed normally.

Please note: dental care is not covered by the coordinated care pathway. You can consult a dentist directly without referral by your doctor. You will be reimbursed normally.