Dáil Éireann díospóireacht -
Wednesday, 28 Jun 2000

Vol. 522 No. 3

Written Answers. - Health Services.

Noel Ahern

Ceist:

177 Mr. N. Ahern asked the Minister for Health and Children if a person with a medical card can call out a bureau doctor at night if his own doctor is unavailable; if a doctor pays for a bureau doctor or suffers any reduction in his payments; the reason a general practitioner should be critical of or discourage a person from calling out a bureau doctor; the procedures involved; and if he will make a statement on the matter. [18776/00]

Minister for Health and Children (Mr. Martin):

Under the terms of the GMS scheme, contracting doctors are required to work a certain number of hours and to be available at other times in instances where their patients have emergency needs. Clearly, particular doctors cannot be available at all times and the issue of providing appropriate cover for their patients therefore arises, especially in so-called out of hours situations, that is late at night, weekends, public holidays etc.

Throughout most of the country, the provision of such cover has traditionally been provided through rota arrangements operated by doctors and encouraged by health boards. In the Dublin and surrounding areas, there are also certain localised rota arrangements in place in certain locations but in other areas of the capital region, GPs have tended to use a bureau service or doctor on-call service. The latter two arrangements involve the participating GPs concerned in paying a certain fee to the commercial service operators to provide cover facilities. In all cases, rota arrangements and bureau and on-call services are private arrangements organised and operated to allow doctors meet their obligations to their patients, both private and public, when they are themselves unavailable.

A medical card holder is fully entitled to contact his or her GP at whatever time a medical need arises although it may be that at that time the doctor concerned is unavailable. In such a situation, the doctor should ensure that the patient is directed to his or her covering service. This could be done, for example, through an answer- machine message. If patients are unhappy with the cover services provided by their GP they should raise the matter with him or her or with the primary care unit of their local health board. Equally, it is not acceptable for a GP to attempt generally to dissuade his or her patients from accessing eligible services at any time they are required. If this is happening the matter should be brought to the attention of the primary care unit of the relevant health board.

The GP providing the cover, whether by rota or otherwise, for the medical card patients of the unavailable doctor is not entitled to charge the patient for eligible services provided. The patient should refer the matter immediately to his or her health board where a request for payment is made in such circumstances.

The entire matter of out of hours general practice service availability is receiving considerable attention in my Department with a view to developing more structured arrangements that best serve patient interests. In the Dublin area, DUBDOC is already in operation from the campus of St James' Hospital and there are plans to develop other similar type GP out of hours arrangements in other parts of the region. Further, CAREDOC, an out of hours GP co-operative, has been launched in the South Eastern Health Board area while a region-wide version of the out of hours co-op model will be commenced in early August throughout the North Eastern Health Board area.

Noel Ahern

Ceist:

178 Mr. N. Ahern asked the Minister for Health and Children the situation with regard to the right of a patient, being the holder of a medical card, to be referred to a consultant; if there is such a right; and the way in which a patient can seek or demand a higher opinion if being refused by her general practitioner. [18777/00]

Minister for Health and Children (Mr. Martin):

The GMS scheme provides medical card holders with a wide-ranging treatment and curative based health care service and medical card holders enjoy full entitlement to be referred to a consultant. Patients, whether public or private, are in the normal way referred to consultants by their general practitioners exercising his or her clinical judgment as to whether such a referral is necessary or desirable having regard to the individual's medical needs. The question of a right to be referred must therefore be understood in that context. Accordingly, there is not, nor can there be, an absolute right to be referred on the basis of the patient's own wishes. The matter is one of clinical judgment.

As in all cases where a patient is unhappy with the clinical decision made by his or her general practitioner, the patient may seek another opinion. A private patient would be put to the expense of obtaining such an opinion whereas a medical card holder need only exercise his or her right to choose another doctor under the terms of the scheme.