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Opinion: Are new medical card plans unfair for GPs?

Making GPs the new rationers of medical card extension could destroy long-established bonds of trust between them and their patients.

Lorraine Courtney Freelance journalist

THE GOVERNMENT’S NEW plans for medical cards announced this week mean that GPs will now be able to renew medical cards for periods of up to 12 months. In “sensitive circumstances” a GP can now reinstate a patients’ eligibility for up to a year and in other circumstances the reinstatement of eligibility is for four months.

Apparently these powers have been in place ever since 2012 but it seems that GPs were broadly unaware of them until this week’s announcement. Minister of State Kathleen Lynch said, “So, it is there, and it’s just to get the message out to GPs that they have the power to do this, and in the event that they feel it’s necessary, they should do it more often”.

There are many positives about the new announcements, if only to prevent potential tragedies like the case of Galway student Conor Cribbin who died by suicide. His medical card had been stopped in the period leading up to his suicide and West Galway Coroner Dr Ciaran MacLoughlin said that while he didn’t know if the issue of Conor’s medical card played a part in what had happened, it should be looked into. He said: “Those drugs are quite expensive and it may have been enough to create a situation he could not handle. This may be one of the consequences of austerity.”

Two-thirds of people who applied for cards this year and were over the income limits were given a card on discretionary grounds, Minister of State for Primary Care Kathleen Lynch revealed. But is giving GPs themselves the power to extend medical cards a good idea?

Desperate patients denied an extension by their family doctor will surely only vent their frustrations on their GP as these doctors assume control of deciding the fate of their medical card extension. At worst, the negative impact for GPs could be individual patients lobbying outside their front door, saying, “You drive a flash BMW but you will not allow me to have this medical card that will save my life”. There will be letters and requests from local councillors and patient groups as well as begging letters from patients themselves to deal with.

Besides, the primary loyalty of any family doctor will be to his patients – not to the State. GP practices are essentially private businesses set up by physician-entrepreneurs, competing for patients, taking the profits, but risking the loss of home and livelihood if it all goes pear-shaped. There is a big danger that they might grant medical card extensions generously in order to preserve business. No doctor is going to risk losing a patient’s business to the GP down the street who is known as been less tight-fisted about approving medical card extensions.

Making GPs the new rationers of medical card extension could also destroy long-established bonds of trust between them and their patients and turn patients into little more than customers who will then shop around trying to get their extension. It really isn’t fair on GPs to have to make this kind of decision on their own patients, often individuals they’ve known and treated for years and who they will always want to give the best possible care. If doctors are to lose the bedrock of trust that underpins the doctor-patient relationship, that would be a tragedy, and undeserved. There is a blatant conflict of interest inherent in this new system that can only jeopardise this very important and complex GP-patient relationship. And it is in everyone’s interest to maintain this relationship.

It seems that the government has seriously misdiagnosed what’s wrong with the medical card assessment system and is putting unfair responsibility on GPs.

Lorraine Courtney is a freelance journalist. Follow her on Twitter @lorrainecath.

Apparently GPs can renew medical cards – but did anyone tell GPs?

Terminally ill patients will no longer have their medical cards reviewed>

About the author:

Lorraine Courtney  / Freelance journalist

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