Rolled out in the Puy-de-Dôme since late 2023, the Healthcare Access Service (SAS) is a key mechanism for improving patient guidance. Led by Clermont-Ferrand University Hospital (CHU) and the SAS 63 Ambulatory Association, and funded by the Auvergne‑Rhône‑Alpes Regional Health Agency, it is based on strengthened cooperation between hospitals and community-based care to deliver a rapid, appropriate medical response and the most efficient patient orientation.
A system designed to simplify the patient care pathway
The SAS addresses a well‑known reality: when a health issue arises, it is not always easy to know whom to contact, particularly when the patient’s regular GP is unavailable.
It is based on shared medical regulation between the SAMU, which handles life‑threatening emergencies, and private practitioners, who are mobilized for perceived urgent situations. Through a single number—15—each caller receives an initial assessment from a medical regulation assistant, followed by referral to the most appropriate response.
This organization clearly distinguishes life‑threatening emergencies, managed by the SAMU, from perceived emergencies, which fall under the SAS. In cases of doubt about severity, calling 15 should never be delayed. For mild and recent symptoms, the first reflex should remain contacting one’s regular GP or using local care options. When these solutions are not accessible, the SAS steps in to ensure appropriate guidance.
A graduated and coordinated response across the entire territory
The SAS brings together a comprehensive network of healthcare professionals across the department: general practitioners, pediatricians, nurses, midwives, multidisciplinary primary care centers, health centers, and non‑scheduled care centers.
Depending on the medical assessment, several solutions may be offered. In most cases, the response consists of medical advice. When necessary, the patient may be referred to a non‑scheduled care consultation—in a private practice, a multidisciplinary primary care center, or a dedicated facility—or, when the situation requires it, to emergency services or emergency medical transport.
This organization helps relieve pressure on emergency departments by reserving them for the most serious cases, while at the same time strengthening continuity of care for patients.
A strong and structuring national framework
The SAS is one of the flagship measures of the Emergency Care Refoundation Pact, reaffirmed during the Ségur de la Santé.
Enshrined in the French Public Health Code (law of 26 April 2021) and governed by the decree of 14 June 2024, it aims to harmonize the regulation of non‑scheduled care throughout France.
The 2024–2029 medical agreement and the national charter of good practice highlight the importance of this regulation, traceability, and fine‑tuned adaptation to local realities.
Some figures for 2025
- 246 professionals are involved in the program
- 167,115 calls regulated by community‑based medicine during SAS operating hours
- 358,743 calls handled by the SAS and the Ambulatory Out‑of‑Hours Care Service (PDSA), covering nights, weekends, and public holidays
- 16,007 referrals to community‑based care
- 4,011 home visits, carried out by doctors or nurses, notably through the Nursing Orientation Service (SIO)
