Thursday, 17 February 2000
Dáil Eireann Debate
168. Mr. Stanton asked the Minister for Health and Children the guidelines, if any, he has issued to assist general practitioners and health boards when dealing with demanding and abusive patients under the medical card scheme; the conditions under which a doctor can refuse to accept these patients; and if he will make a statement on the matter. [4774/00]
Minister for Health and Children (Mr. Martin): Health boards are required to provide general practitioner services to all medical card patients and such services are provided by doctors holding general medical services scheme contracts. The contract sets out both the conditions under which services are to be provided to medical card holders and the relationship between the board and the contracted doctor in terms of accepting and assigning patients.
The contract provides that in a situation where a general practitioner does not wish to accept a particular patient he or she can be requested by the board to provide, confidentially, the reasons for his or her unwillingness. Ultimately, however, the board has, under the contract, the power to assign patients to ensure their medical needs are met. Where assignment takes place, there is provision for such assignment to be reviewed at the doctor's request after a six months' period.
While no formal guidelines have been issued by my Department, the matter of dealing with difficult or abusive medical card patients is one which the community care and primary care units  in each health board are best placed to deal with given their specialist local knowledge. In such cases, the units will generally work with the doctor or doctors involved to ensure the provision of a service and with the patient to see that he or she understands the importance of maintaining a mutually co-operative relationship with their general practitioner.
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