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BRITS IN FRANCE

What are the rules on accessing the UK health service if you live in France?

If you're British and live in France you will previously have been registered with the National Health Service, but once you move abroad things change - here's what this means for accessing UK healthcare both on a regular basis and if you have an accident or fall sick while on a visit back to the UK.

Published: 19 October 2022 17:00 CEST
What are the rules on accessing the UK health service if you live in France?
Photo by JUSTIN TALLIS / AFP

The NHS is described by the British government as a “residence-based health service” which means that if you don’t live in the UK you’re not automatically entitled to NHS care, even if you are a British citizen and even if you still pay tax in the UK.

However funding, access and care rules can vary depending on your circumstances.

Moving to France

Once you have lived in France for more than three months you are entitled to register in the French health system and get a carte vitale – here’s how to go about getting the card and registering with a French GP.

This will take care of your regular healthcare needs, GP appointments, screening, planned procedures etc.

Healthcare in France is a state system, but unlike the NHS it’s not free at the point of delivery, instead it operates on a reimbursement system.

READ ALSO How France’s healthcare system works

Pensioners

If you are a pensioner, student or posted worker, it’s likely that the UK will continue to pay for your healthcare through the S1 system.

However, being covered by S1 doesn’t mean that you remain registered with the NHS – S1 only affects who pays for your care.  

So, in France, you register for a carte vitale health card in the same way as everyone else, you pay upfront for your medical treatment and then the doctor swipes the health card – at this point, if you are an S1 holder, the UK government reimburses the cost, for everyone else the French government pays the cost. But for you as a patient, the system is the same.

Full details HERE on how to request an S1. 

If you are not working, studying or seeking work in France but have not yet reached pension age you could fall into a ‘grey area’ in terms of who pays for your healthcare – in this case you can register in the French system through PUMa – full details on that HERE. 

Can I stay registered with my UK GP?

No, you need to have a local address to be registered with an NHS GP. In practice, many people don’t get around to telling their GP that they have moved and so stay registered for months or even years, but technically you should notify your GP so that you can be removed from the NHS register. 

Even if you do remain registered with a UK GP, they won’t be able to issue prescriptions for you in France as most UK GPs are not licensed to practice outside the UK – therefore are not covered by insurance.

If you are on regular medication it may be possible for your GP to issue you with an advance stock of medication to cover you while you get settled in France, but many prescriptions are limited to a maximum of three months.

What about travelling outside France?

Once you’re registered in the French system you will be able to get a European health insurance card known as a CEAM (Carte européenne d’assurance maladie) which covers medical care while on trips in Europe. It’s basically the same as the EHIC you might have had while you were registered in the UK but it’s not issued automatically, you have to request it.

The easiest way to do this is through your Ameli account – head to ‘Mes informations‘ than click the ‘commander une carte européene d’assurance maladie‘ in the box next to the CEAM. It will be sent by post to your French address. 

If travelling outside of Europe – ie a holiday in the US – you need to ensure that you have travel insurance with full medical cover in case of any mishaps while abroad. 

What about trips back to the UK?

Although your day-to-day healthcare will be covered by the French system, there’s still the possibility or falling sick or having an accident while on a trip back to the UK. 

If you are an S1 holder you can show this to provide proof that you are entitled to NHS treatment, and if you are covered by the Brexit Withdrawal Agreement you can show your UK-issued EHIC or GHIC to provide proof of your entitlement to NHS care.

However if you don’t have either of these, the CEAM covers all trips in the EU and European Economic Area, as well as Switzerland and the UK, so if you are charged for medical care while in the UK – because you do not have a UK address – then you will be able to claim the costs back once your return in France.

This also means that any French nationals who are with you on your trip – such as a French spouse or partner – have their care costs covered too through CEAM. 

In practice, most UK nationals who need to use the NHS while on trips back to the UK report that no-one ever thinks to ask whether they are UK residents.

It’s true that some Brits living in France keep their registration with a UK GP and make regular trips back to get prescriptions, while this can happen in practice it does involve lying or at least being economical with the truth about where you live.

Overall it’s better to get registered with a French GP so that they can get to know you and have a full overview of your care as well as any ongoing medical conditions and prescriptions. Most Brits are pretty happy with French healthcare, which consistently ranks among the best in the world. 

Emergency care

There are certain types of NHS care that are not charged for, such as A&E treatment or treatment from paramedics, but if you need to be admitted to hospital you may have to pay.

NHS hospitals won’t turn you away if you cannot prove residency, but they may present you with a bill when you leave if you cannot prove either residency or health cover in a European country.

Member comments

  1. They do ask even though I’m UK resident, and sounded here like an automatic question, but may not be I suppose unless like me you rarely ever go to the GP.

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SCHOOLS

Are packed lunches really banned in French schools?

School children in France are entitled to a lunchtime meal of three, or even four courses – but what if you prefer to provide meals yourself? 

Published: 22 May 2024 12:24 CEST
Are packed lunches really banned in French schools?

French school meals are, famously, pretty good – children get a three or even four-course meal of properly prepared dishes and the menu (including cheese course) is usually published in the local town newsletter so everyone can see the types of meals being served.

The concept of a proper meal at lunchtime is an important one. “The diet of a school-age child is essential for their growth, mental development and learning abilities,” the French Education Ministry says in a preamble about school meals on its website. “It must be balanced, varied and distributed throughout the day: for example 20 percent of total energy in the morning, 40 percent at midday, 10 percent at four o’clock and 30 percent in the evening.”

And it’s not all about nutrition, the social aspect of sitting together and eating a meal is also important – the ministry continues: “Mealtime is an opportunity for students to relax and communicate. It should also be a time for discovery and enjoyment.”

All schools provide meals in a canteen and most pupils take up the opportunity – however it’s also possible for pupils to go home at lunchtime so that they can eat lunch with their parents.

The idea of taking in a packed lunch (panier-repas) is much less common in France – but is it actually banned?

The rules on lunch

At écoles (up to age 11), the local authority or établissement public de coopération intercommunale (EPCI) is responsible for providing quality school meals. This generally involves meals being provided via a central kitchen, and then delivered to the school’s kitchen, where it can be kept warm, or reheated as necessary.

The system is slightly different in collèges and lycées (attended by children aged 11 and up). In those establishments, catering falls into the purview of the wider département or region – and is routinely managed directly by individual establishments, which will have catering staff on site to prepare meals. Often, meal services are outsourced to private businesses, which operate the kitchens.

There are various rules and regulations in place regarding what food is offered, and how long a child has to eat – which is, in part, why the school lunch period is so long. Children must be allowed a 30-minute period to eat their meal, from the moment they sit down with it at the table. 

Then, they’re given time to play and relax before afternoon classes start.

READ ALSO What you need to know if your child is starting school in France

At a minimum lunch must include a main course with a side dish, a dairy-based product, as well as a starter and/or a dessert. Meals must also, the government says, be composed of 50 percent sustainable quality products (including 20 percent organic).

Some local authorities go further and serve only or mostly food that is organic, locally sourced or both.

Water and bread must be freely available, but salt and condiments can only be added in preparation – no sauce bottles or salt and pepper on the tables. 

Daily menus are generally available to view on school websites and many town newspapers or newsletters also publish them.

Parents pay a fee for the school lunch, which is calculated according to income and can be free in the case of low-income families.

Packed lunch

But what if your child doesn’t like the school lunches and you don’t have time to pick them up, cook a full lunch and take them back in the afternoon everyday? The obvious solution would seem to be to send them in with a packed lunch, as is common in the UK and USA.

In theory this is possible, but only in certain circumstances and with very strict rules and caveats. 

The Ministry, in a written response to a Senator’s question in 2019, said: “The use of packed lunches [home-supplied meals] by primary school students can provide an alternative to school meals. This method of catering is authorised in particular for children with a medically established food allergy or intolerance, requiring an adapted diet.”

READ ALSO How to enrol a non-French speaking child in school in France

It added: “the preparation and use of packed lunches in schools must follow certain rules. First of all, it is important to respect the cold chain”.

The cold chain is a term applied to food handling and distribution – it’s usually used by food-preparation businesses, but in the context of a packed lunch it means that food prepared at home must be kept in appropriately cool conditions until it is ready to eat. It would be the responsibility of parents to ensure that the food is delivered to school in containers appropriate for the job (ie an insulated cool bag).

Once at the school, it is up to whoever manages the kitchen to ensure that food is properly reheated. This becomes the sticking point at which many parents’ requests to send their children to school with a packed lunch, rather than go to the canteen, or eat back at home, are refused.

The reheating concern suggests that schools are also expecting parents to prepare a proper meal – rather than just throwing some sandwiches and a cereal bar into a bag.

Unless there’s a genuine and proven health reason for your child to eat a home-prepared meal, most parents will probably find the school won’t budge on this – even in cases of a strike by kitchen staff or lunch monitors.

READ ALSO Just how much do private schools in France cost?

The Ministry’s written response explains: “[A]s this is an optional public service, the municipality can justify its refusal to admit the children concerned by objective material and financial constraints, such as the need to equip itself with additional refrigerators, or for additional supervisory staff to supervise them during lunch.”

As well as the practicalities, for some schools this is an equality issue – because of the varied fee structure for school lunches what happens in effect is that richer parents are subsidising a good quality lunchtime meal for poorer students in the class; if everyone brought in a packed lunch and therefore stopped paying the fee, the lower-income kids would miss out. 

What about allergies or other health issues?

Children with allergies or other health issues that require a particular diet must be accommodated. An individual meal plan – known as a projet d’accueil individualisé (PAI) can be set up. More details (in French) are available here, on the government’s website.

It also becomes easier for parents to provide home-produced meals in such instances. As ever, it is up to the parents to ensure any meals are appropriately packaged and transported to school.

Not all schools

Some individual schools in France do permit pupils to bring in meals from home. They must be taken to school in an appropriate cold-storage container, and they will be stored in the kitchen area until they are needed, when meals will – if necessary – be reheated.

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