October 2018

The early signs and missed opportunities

Lilly, a previously healthy child with no history of medical issues, first developed a fever and showed signs of erratic breathing and low fluid intake. Her parents sought medical advice by calling 111 on November 4, 2017. The advice given was to visit an out-of-hours surgery, where a GP diagnosed a mild upper respiratory tract infection. Lilly was prescribed paracetamol and ibuprofen, with instructions to seek further medical help if her condition deteriorated.

Though there was slight improvement initially, Lilly’s condition quickly worsened by the following day. She developed a rash on her face, torso, and behind her ears, became lethargic, refused fluids, and had dry nappies. Concerned, her parents took her to the St Mary’s Hospital Walk-in Centre, where she was diagnosed with tonsillitis and prescribed antibiotics. The doctor, however, also consulted Portsmouth’s Queen Alexandra Hospital (QAH), where Lilly was advised to attend for further examination.

At QAH, a consultant ruled out the need for antibiotics, believing the infection was viral. Lilly was discharged later that evening with an open-access 72-hour follow-up, just in case her condition worsened.

The deterioration of Lilly’s condition

Unfortunately, within 24 hours, Lilly’s condition significantly deteriorated. Her parents returned to QAH, where after an initial examination, Lilly was left unattended in her pushchair for several hours. Despite her visible distress, there was little communication from the medical team. At around 2 a.m., a doctor administered a throat spray in an attempt to ease her discomfort, but shortly thereafter, Lilly was sent home with no clear diagnosis.

By midday, Lilly’s condition had worsened further. Her lips turned blue, and her oxygen levels dropped. This prompted a rapid intervention, and Lilly was rushed to the resuscitation room. Broad-spectrum antibiotics were administered, and an x-ray revealed pneumonia and a large buildup of fluid in her lungs. The specialist at Southampton General Hospital (SGH) advised immediate transfer.

A life-threatening situation

Upon arriving at SGH, Lilly’s condition was dire. Her parents were informed that Lilly may lose her leg due to the arterial line placed during her transfer, which had impaired blood flow to her foot. Lilly was later diagnosed with sepsis and pneumonia, and 650ml of fluid was drained from her lungs. The medical team acted swiftly to save her life.

The long-term impact

Though Lilly survived the ordeal, she has been left with lasting health concerns. Her mother, Danielle Barter, expressed the family’s distress: “The whole experience was extremely frightening, and we wouldn’t want any parents to go through what we did. Thankfully, Lilly has recovered from pneumonia and sepsis, but the prognosis for her foot and leg remains uncertain.”

The importance of early sepsis diagnosis

Lilly’s case underscores the importance of early diagnosis and treatment for sepsis. Sepsis, a life-threatening condition caused by infection, is responsible for more deaths in the UK than breast, bowel, and prostate cancer combined. Experts, including Janine Collier, Executive Partner and Head of the Medical Negligence Department at Tees, emphasise the importance of adhering to guidelines issued by the Sepsis Trust and NICE to help healthcare professionals recognise the signs of sepsis early and initiate the correct treatment.

Janine Collier added: “Sepsis is a medical emergency, and early recognition can make all the difference in preventing long-term complications or even death. We will be closely reviewing the facts of Lilly’s case to determine if her treatment was delayed unnecessarily.”

This case serves as a stark reminder of the potential consequences of failing to act on early signs of sepsis, especially in vulnerable children. Early intervention not only saves lives but also maximises the chances of a full recovery without lasting complications.

It is possible to start a simple business quickly and cheaply in France. Larger and more complex enterprises may require expert advice to ensure that they are registered correctly and comply with the relevant regulations.

While many of the things you’d do when setting up a business are the same in France as in the UK, for example preparing a business plan and researching your market and competitors, it is often the company structures and business regulations in France that can deter people from setting up their own business there. It is true that France does appear to have a baffling number of processes, but it has in fact been made easier for business start-ups in recent years and many aspects have been simplified.

Here we take a look at the steps to consider:

French legal business structures

There are two types of legal business structure in France:

Sole trader (entreprise individuelle or EI)

If the business you are hoping to set up is small and you do not need any significant funding, it is likely that an entreprise individuelle (EI) will work for you. This is what we would call a sole trader business in the UK. In addition, you can set it up using the business tax status of micro-entrepreneur, which protects your family home from business creditors.

A company (société) such as EURL and SARL

However, if your business requires a loan, is likely to make a loss in the first years, or you are running it with non-family members, then you would be better advised to set up a limited liability company. The most common types are the entreprise unipersonnelle à responsibilité limitée and the société à responsibilité limitée, which are abbreviated to EURL and SARL.

These different structures have a variety of tax implications, i.e. they determine whether you are taxed through your business or your personal income tax. Additionally, there are other types of company for more complex structures, which you would be advised to discuss with an expert in French company law.

It is worth noting that if you are a national of the European Economic Area (EEA), you do not need a residence or work permit to start a business in France.

Registering a business in France

All new businesses in France need to be registered with the authorities, and this is done at a business registration centre known as a centre des formalités des entreprises (CFE). This does the job of notifying all the relevant statutory bodies who need to be aware of your business, such as tax and social security organisations.

You can do this yourself very cheaply if your business is a simple entreprise individuelle, but for more complex business structures, while it is still possible to do it yourself, you are probably better advised to use the services of an avocat (a French lawyer) or an accountant.

Confirmation of your registration usually takes about two weeks, after which you will receive a business identification document, which is called an extrait K for a sole trader or an extrait Kbis for companies. You will also be given a 14-digit business registration number known as your SIRET (the first nine numbers refer to your identity on the national business register, while the last five identify the area in France in which your business is located).

French business classification

There is also a system of classification for all businesses in France that identifies whether your business is a trade, a profession or commercial, or whether you are working as an agent, in agriculture or in the artistic sector. You will need to decide which of these your business falls into when you register the company – if your business falls into two categories, then you should register your principal activity. Your local French chamber of commerce should be able to help you decide on the appropriate category.

French business insurance

Consider taking expert advice regarding your public liability and professional indemnity insurance. While it is not obligatory for all business activities, your business classification will identify what cover is required and premiums can be high.

Finding business premises in France

It is possible to run your business from home in France without any change of use from the planning authorities as long as the property continues to be your home. You may have issues with neighbours, however, and if you are receiving clients or goods to your home address you should apply to your local mairie/préfecture for consent. You should also check your lease if you live in a block of flats, as there may be a clause there which states that commercial activities cannot be carried out on the premises.

Buying business premises in France is fairly straightforward, although you should consider using a legal structure called a société civile immobilière (SCI) as it can offer some financial advantages.

If you buy an existing business and premises, you will be required by French law to respect existing employment contracts. Also remember that France has regulatory requirements for certain types of business, e.g. health and safety if you are considering opening a food-related business.

French business banking and accounting

If you have a separate business in France, you are required to open a business bank account in the same name as the business. You may receive an introduction to a bank when you register your company and it may be necessary to visit the bank in person and to take a copy of your business plan with you. There is likely to be a minimum deposit required and a quarterly charge for your business account.

If you have chosen to trade as an entreprise individuelle, the authorities are usually happy for you to manage the book-keeping yourself, and the same is true if you opt for the micro-entrepreneur tax regime – as long as you keep a book of expenditure and receipts and have this available for possible short-notice inspection.

Although you’ll most likely be willing to do the book-keeping for your new business yourself, it is worth (and this could save you money in the long run) appointing a professional French accountant with commercial expertise, otherwise known as an expert-comptable. They are legally responsible for keeping you informed of changes to the tax laws and for keeping your accounts in good order.

Financial assistance for starting a business in France

A good expert-comptable will also be able to advise you on the best way to access financial assistance for your new start-up. There are many schemes available, and it is worth taking the time to research the one that would be best suited to your business and situation. They will often include tax and social security savings, as well as offering grants or low interest rate loans. The government offers subsidised employment contracts to certain business sectors if you are able to offer jobs to the unemployed, the young or the elderly.

Paying tax in France

How you pay tax will be dependent upon the structure you have chosen for your business, and will either fall under the personal income tax system called impôt sur le revenu or the company tax system known as impôt sur les sociétés.

If you are a sole trader, then you are automatically taxed under the personal income tax system. A limited company in sole ownership can choose to be taxed through either system, while a limited company in joint ownership should be taxed under the company tax system.
Whichever way you pay your tax, you will pay your social security contributions under the régime des travailleurs non salariés (TNS).

Employing staff for your new business

You can find staff via recruitment agencies, newspapers and online much as you would in the UK, or you can use the pôle emploi, which is the national job centre. However, employment law is complicated in France and it is a good idea to contact a specialist French lawyer who will advise you as to whether you have the correct business structure to employ staff. They will also help you to declare your new member of staff to the relevant authority, as well as ensuring that you comply with all other conditions of employment.

Marketing your business

If you are marketing your business in France, i.e. if you are not relying solely on clients from the UK, you must remember to be sensitive to French traditions and protocols. As in the UK, get to know your market and identify appropriate advertising channels. Write all your marketing communications in French and do not presume that you can simply translate any existing materials, which will target the English market, into French.

If you are about to start a business in France and want help at any stage of the process, our French-speaking legal team can give you the straightforward advice you need. The team is led by our French-qualified avocat Herve Blatry, based in our Bishop’s Stortford office, who has extensive experience of conducting business in France and will be able to offer specialised advice and secure you the best results.

Call our French legal team on 01279 322 515 for an initial obligation-free chat, or fill out our enquiry form and we will get in touch.