The primary care system, often called the Primärarztsystem, has been on the health policy agenda since the coalition agreement, and many insured people ask whether they will soon have to see a family doctor first. For the present the answer is clear: there is no general obligation. What comes next has been announced politically, but not enacted.
In short: No, you do not have to see a family doctor first today. Under section 76 (1) of Book V of the Social Code (SGB V), you can freely choose among doctors admitted to statutory care. A binding primary care system is planned, but it is not enacted law. Reports mention first effects in 2028 at the earliest. Last updated: November 2026.
Key Points
- Free choice of doctor applies among doctors admitted to statutory health insurance care. German law contains no general family doctor requirement.
- Family doctor models offered by health insurers are a voluntary form of care with their own conditions.
- The primary care system is part of the coalition agreement, but no law has been passed.
- A referral as the standard route to specialists is under discussion, with exceptions such as gynaecologists, eye doctors and dentists.
- Which steering tool will be used is open: a bonus, a fee, or no coverage for specialist visits without a referral are all conceivable.
Do I Have to See a Family Doctor First Today?
No. The basic rule is in section 76 (1) sentence 1 SGB V: insured people can choose freely among doctors admitted to statutory care. Sentence 2 allows other doctors only in emergencies. This provision does not mention a referral as a precondition for seeing a specialist. In everyday life, whether you need a referral therefore depends less on the statute than on the practice and on your form of care. We cover that in the guide on the GP referral for specialists (in German).
Another point from the same provision concerns switching: within a calendar quarter, insured people should change their contract doctor only for good cause (section 76 (3) SGB V). That is a “should” provision, not a prohibition. The practical difference from a primary care system is that today you can contact a specialist directly, even if the waiting time there seems longer than at the family doctor.
What Is a Family Doctor Model and How Does It Differ From a Primary Care System?
A family doctor model is an offer from your health insurer in which you voluntarily commit to seeing a chosen family doctor first. The conditions, such as the commitment period and exceptions, are set out in your insurer’s terms. A primary care system would instead be a statutory basic framework for all insured people. The difference lies in voluntariness: in a model you decide, in a system the legislator decides.
| Feature | Today | Planned primary care system |
|---|---|---|
| Legal basis | Section 76 SGB V (free choice of doctor), voluntary family doctor models | Law announced, not enacted |
| First contact | Freely chosen among admitted doctors | Primary care provider as first point of contact (planned) |
| Access to specialists | Direct, with a referral depending on the practice | Referral requirement under discussion |
| Exceptions | Emergencies | According to ministry plans dentists, gynaecologists, eye doctors; others open |
| Timing | applies now | Reports: first effects in 2028 at the earliest |
What Is Planned Politically and What Is Documented?
The reform is part of the coalition agreement. According to a page published by the AOK on 30 October 2025, the Federal Ministry of Health had announced a bill for early 2026, and at that point only key points had been presented. The Bundestag’s lobbying register lists the regulatory project “introduction of a GP-led primary care system” (Einführung eines hausärztlichen Primärarztsystems) as being in the preparation phase (page dated 24 October 2026, accessed 2 November 2026). A ministry draft is announced there for summer 2026, but no draft or parliamentary paper is listed. State Secretary Tino Sorge told the Bundestag petitions committee that no solution would be on the table by the end of the year. In the concept described there, primary care providers would deliver initial care and decide with you whether specialist treatment is needed.
According to ministry plans, dentists, gynaecologists and eye doctors would be excluded from the system and directly accessible. The AOK concept also lists children’s and youth practices, chronically ill patients and preventive check-ups as possible exceptions to a referral requirement. The same page says it is still open how to treat patients who do not want to follow the system. The AOK relies on a survey it commissioned from Forsa, in which 79 percent of respondents wanted a fixed point of contact and 55 percent supported specialist appointments only after a referral. These are opinion snapshots, not legal rules.
According to reporting on statements by Health Minister Nina Warken (as of 27 January 2026), first effects are expected in 2028 at the earliest. Named as possible steering tools are a bonus for visiting the family doctor, an additional fee, or no coverage for specialist visits without a referral. Which of these will be chosen has not been decided. Everything here describes plans and concepts, not applicable law.
What Would a Primary Care System Mean for Students?
Students often move and frequently do not have a regular family doctor. A primary care system would require this group to find a family doctor in the new city before a specialist appointment becomes possible. The appointment system is a further question: the appointment service on 116117 already arranges appointments today, and the emergency reform reorganises the number into an appointment service and an acute care control centre. How both would work with a future primary care system has not been settled.
Assumption: you move to a new city in October and have no family doctor there. Today you can contact a specialist directly if the practice allows it, or use the appointment service. If a referral requirement applied later, you would normally need a family doctor appointment first. Looking for a practice early therefore puts you in a better position either way. Tips are in the guide Finding a family doctor as a student (in German).
Where Can You Check the Legislative Status?
A law applies only once the Bundestag has passed it, the Bundesrat has been involved and it has been promulgated in the Federal Law Gazette (Bundesgesetzblatt). You can find bills in the Bundestag’s documentation and information system (DIP) and on the Federal Ministry of Health’s pages on laws and ordinances. News reports about key points or ministry drafts are not yet a legislative status. The other health system reforms are placed in context in the overview of the emergency care reform 2027 and related topics.
Frequently Asked Questions
Has the primary care system already been decided?
No. There is a political announcement under the coalition agreement, but no passed law. Reports say first effects are expected in 2028 at the earliest. Until then nothing changes about free choice of doctor.
Do I need a referral for a specialist today?
The statute does not prescribe one in its basic rule on free choice of doctor. Depending on the form of care, the practice or your insurer’s family doctor model, a referral can still be required. Ask the practice or your insurer before booking.
Would a primary care system also apply to privately insured people?
No documented information is available on this. The plans described so far concern statutory care. Whether and how privately insured people would be included depends on the later legal text.
Does the exception for gynaecologists and eye doctors apply already?
No. It is part of ministry plans as reported in the AOK description. Today you can see gynaecologists and eye doctors directly anyway, unless the practice asks for a referral.
What to Do Now
- Check your health insurer’s terms for a family doctor model and what participation requires.
- Look early for a family doctor practice in your university town that accepts new patients, and note the contact details.
- Ask in advance whether a specialist practice requires a referral, and use the appointment service if needed.
- When political news appears, check in the DIP or with the Federal Ministry of Health whether a law has been passed and promulgated.
Related Articles
- GP referral for specialists: do I need one? (in German)
- Getting a specialist appointment faster: using the 116117 service
- Finding a family doctor as a student (in German)
- 112 or 116117: the right number in an emergency (in German)
- Emergency care reform 2027: the new rules
Sources: Section 76 SGB V, free choice of doctor (statute text, accessed November 2026, in German), AOK Federal Association, law on primary care in planning (30 October 2025, in German) and ZDFheute on the Health Minister’s plans (27 January 2026, in German) and the Bundestag lobbying register, regulatory project RV0022629 (page dated 24 October 2026, in German). Personal advice on forms of care and health insurance is available from Academycon at How we work (in German).
Last updated: November 2026. This guide is general information, not individual advice.
