MEDICAL CHARITY BOSSES have claimed that a sudden change to the way asylum seekers are assigned to GPs is cutting off vulnerable people’s access to primary care.
One medical charity boss has said that she has recently witnessed people who arrived in Ireland with a pre-existing cancer diagnosis having to go to emergency departments for check-ups. She said the problem is the latest barrier that asylum seekers have come up against in getting access to primary care in Ireland.
Previously, people receiving temporary protection in Ireland such as Ukrainians, and international protection applicants (asylum seekers from other countries) were being assigned to a GP after being refused by three practices who were not in a position to take them on.
Two leaders of non-profit organisations that work to ensure asylum seekers get access to healthcare in Ireland have said that since the implementation of the new GP contract at the start of this month, the process by which asylum seekers were previously assigned to a GP has come to a standstill.
The Irish Medical Organisation has said that the new GP contract should not be causing the standstill in assignments, as the annual cap for assignments should not have been reached yet.
This assignment process usually takes place through the Primary Care Reimbursement Service (PCRS).
The PCRS is a national service which is part of the HSE, it manages the national medical card unit, which assesses medical card and GP visit card applications.
Under the new 2023 GP contract, the number of assigned patients that each GP has to take on is restricted, with a cap put in place.
However, Sinn Féin spokesperson on health David Cullinane told The Journal that he is highly concerned that the Government has agreed to a cap on the number of patients GPs can be assigned in general.
He has called on the Minister for health to “undo this major mistake”.
“It is deeply frustrating that the Minister would agree to remove the obligation on GPs to take patients assigned by the HSE. This was only used in 1% of cases but was vital to those people,” Cullinane said.
He said that beyond the asylum seeker cohort, this new restriction on patient assignments will impact “any person with a GP visit card”, including “all of the 400,000 new cards for people who earn up to the median income.”
“Many of them will not be registered with a GP, and now they will have free access but no service. The Minister must undo this major mistake,” Cullinane added.
Fiona O’Reilly is the CEO of Safetynet, a medical charity that provides care to homeless people, drug users and migrants who face difficulties accessing care otherwise.
She said that the current “pause” in the assignment process is leaving asylum seekers dependent on weekly or bi-weekly “pop-up” clinics run by sessional GPs who are contracted by local health services – a practice that became more widespread after the invasion of Ukraine.
“The problem is that these clinics are not available in every county or locality.
“It also means that asylum seekers are limited as to when they can access care, and that creates a two-tiered system that could see tens of thousands of people living in tents, direct provision and hotels having their access to primary care massively restricted,” she added.
It is understood that officials within the HSE have met with medical charity representatives in the last week to hear their concerns about changes to the assignment process, but that little explanation as to what is currently happening within the system has been offered.
The Journal asked the HSE for comment on this issue, but has received no reply at the time of publication.
“The assignment mechanism has worked very well over the last year, in a time period where we saw an influx of migrants and international protection applicants, Before that, it was very rarely used.
“We also have concerns about which asylum seekers will be assigned to GPs under the new restrictions. What will the criteria be? Will sicker people be prioritised? These are the questions we are seeking answers to,” O Reilly explained.
Tonya Myles, the General Manager of Cairde, a frontline health information and advocacy service that works with marginalised communities, said that in the last month she is seeing new cases every week involving migrants, including international protection applicants, who cannot get assigned to a GP.
“The biggest issue we are seeing in the Dublin area is not so much in relation to people in emergency accommodation, but more so relating to migrants who have moved out of that type of accommodation into urban centres and remote areas, where all of the GPs are already full,” she explained.
“The assignment process has been very useful for us because in cases where a GP could not be found, we could go back to the PCRS and our client would be assigned a doctor through this mechanism.
“As far as I know, this isn’t happening anymore,” Myles explained.
“This becomes really difficult when a migrant has a pre-existing health condition, like a cancer diagnosis or another serious illness, and we still cannot find a doctor’s office that is able to take them on – which is a reality some are facing,” she added.
O Reilly, from Safetynet, said that the charity often works with asylum seekers who are experiencing specific health difficulties.
“During the pandemic, the worst spread happened in congregated settings, it is the same with colds, and the flu, and we see it in accommodation where strangers are sleeping in the same rooms.
“In a lot of types of accommodation, parents aren’t able to cook food for their children, they are given limited kinds of food, and that can have an impact on people’s health. Some people are also coming from countries where they haven’t had access to any kind of healthcare, and so they have pressing needs. This is also true for people who have gone through traumatic experiences prior to arriving in Ireland, and have not been able to access mental health supports,” O Reilly said.
She added that sometimes the health conditions faced by asylum seekers are caused by the accommodation they are living in, with scabies outbreaks being something Safetynet comes across on a regular basis.
The Department of Health issued a statement which said: “Patient choice of doctor is a bedrock principle of the General Medical Services (GMS) Scheme for medical card and GP visit card holders.
“For the vast majority of individuals concerned, their choice of doctor is accommodated, and they are registered with their GMS GP of choice. For individuals unable to locate a GP themselves, the process whereby the HSE may assign an eligible person to a GP’s GMS panel remains in place, in line with GMS contractual arrangements.”
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