Out-of-hours care or phone answering service: do not confuse them

In everyday language, “permanence” (cover, availability) suggests someone answering. This is what causes confusion in healthcare. In France, the permanence des soins ambulatoires (PDSA, out-of-hours ambulatory care) is a regulatory scheme that aims to meet unscheduled care needs. A telephone answering service, by contrast, takes calls on behalf of a business, answers practical questions and passes requests on.

This article describes these two notions without giving medical advice: it is aimed at professionals who write a greeting message or choose a telephone answering service. The legal texts below are French.

Words matter, because patients are looking, on the phone, for who can help them. A greeting that announces “permanence” without saying what it is can suggest that a doctor can be reached when it is a switchboard. Clarity of vocabulary is part of the information given to patients.

According to Article R6315-1 of the French Public Health Code (Code de la santé publique), the out-of-hours care mission aims to meet unscheduled care needs. According to the texts, it operates every day from 20:00 to 8:00, on Sundays and public holidays from 8:00 to 20:00, and in other periods according to the population’s needs (for example part of Saturday). It is provided in particular by doctors working in practices, health houses (maisons de santé), health hubs (pôles de santé) or health centres (centres de santé), and may involve, depending on demand for care and existing provision, health establishments as well as, on a voluntary basis, nurses and midwives.

Its organisational principles are set out in a regional specification issued by the director general of the regional health agency (the ARS, agence régionale de santé) (Article R6315-6). Doctors take part on a voluntary basis (Article R6315-4) and enter their on-call shifts in a schedule sent to the departmental council of the medical association (conseil départemental de l’ordre des médecins), which passes it on in particular to the agency (Article R6315-2). Answering the phone is therefore not, in itself, enough to take part in this scheme.

Article R6315-3 provides that access to the out-of-hours ambulatory care doctor, nurse and midwife is subject to prior telephone medical regulation, available across the whole country through the national out-of-hours care number (116 117) or the national emergency medical assistance number (15). The regulating doctor, under Article R6315-5, decides on the response suited to the request for care. The director general of the regional health agency determines which of these two numbers is used in the region and records it in the specification (Article R6315-3).

The ARS Île-de-France also describes the service d’accès aux soins (SAS, care access service): reachable on 15, which is not reserved for life-threatening emergencies, it connects the caller with a doctor who can give advice, direct them to a suitable consultation or trigger suitable resources; the agency states that the SAS’s general-practice regulation complements the out-of-hours ambulatory care scheme. The medical decision is therefore made by a regulating doctor, not by a switchboard.

For the professional writing their messages, keep two points in mind: the medical decision belongs to the regulating doctor, and the number to give depends on regional organisation. Do not copy a message from another area without checking that the out-of-hours care number and hours match your region.

A telephone answering service, provided by a secretary, an external answering service or a voice agent, answers in the name of a business: hours, appointment arrangements, administrative procedures, message-taking with the caller’s contact details, passing on to the professional. It does not regulate, does not make diagnoses and does not give medical direction: its value lies in the reliability of practical information and in passing things on.

To avoid ambiguity, avoid using the expression “permanence des soins” to describe a simple answering service, and do not present an answering service as a medical regulation service. In an emergency, direct callers to 15 (medical emergency) or 112, numbers given by Service-Public.gouv.fr (France’s official administrative information portal).

For an external answering service or a voice agent, the scope is better described by what it covers (practical information, appointments, passing on) than by what it replaces. Write it in your documents and on your website: “telephone answering service” rather than “permanence” if the service does not provide medical regulation.

A practice greeting message can follow a simple outline: name of the business, hours, requests the switchboard can handle, direction to 15 in an emergency, and, outside hours, the out-of-hours care number in force in your region (116 117 or 15 depending on the regional specification). Check this number with your ARS or your professional organisation, and have the text validated by the practitioners.

Alyas, an AI voice agent, provides telephone answering, not regulation: it answers using the information you give it, announces at the start of the call that it is an AI and that the call is recorded, captures the contact details and leaves the transcript and summary in your workspace. If it does not know, it says so and offers to pass the request on. The trial is free for 10 days, with no card required.