Long-term illnesses in France: what has changed?
France introduces new role for nurses in long-term illness care
Only one primary nurse can be assigned at a time
Dragon Images/Shutterstock.
People with long term illnesses in France (affections de longue durée, or ALDs) are now able to designate a primary nurse to help manage their care.
ALDs cover serious or chronic illnesses requiring prolonged treatment and ongoing medical follow-up, and they already benefit from specific reimbursement rules. For a full breakdown and how ALDs work and what they mean for healthcare costs and reimbursements, see our explainer here.
Designate a primary nurse in France
Since May 2026, people with long term illnesses can appoint a referring nurse (infirmier referent) to support them.
The designated nurse acts as a liaison between the patient and the healthcare professionals involved in their care.
The aim is to improve the continuity of care for ALDs patients and strengthen communication between health professionals, including GPs, specialists, hospitals, and social care services.
Who can appoint a primary nurse?
The nurse has to be the patient's choice (and of course must agree to take on the role). The possibility is open to:
Patients aged 16 and over with an exempt ALD
Eligible beneficiaries under the same conditions
Minors, with the agreement of at least one parent or legal guardian
Only one primary nurse can be assigned at a time. However, nurses that work in the same practice can cover one another if needed.
From July 2027, for certain patients (especially elderly or disabled patients) requiring assistance to access medical care, the referring nurse will be required to take part in enhanced monitoring of their care pathway.
How to do it
To declare a primary nurse, patients must complete the “Declaration of Choice of a Referring Nurse” form, signed by both the patient and the nurse. Three copies must be made: one for the patient, one for the nurse, and one for the local health insurance fund (CPAM).
The declaration is made during an in-person consultation, after which the nurse sends the form to CPAM by post.
