System to reinstate medical cards is ‘flawed’

GPs have claimed the HSE’s system for allowing them to reinstate medical cards is "fundamentally flawed", warning that doctors have been repeatedly blocked from using the alleged two-year-old power.

The National Association of General Practitioners hit out at the situation yesterday — saying the previous deal has been deliberately misinterpreted — and casting fresh doubt over a key element of plans to reform the medical card system.

On Tuesday, Leo Varadkar, the health minister, announced a series of changes he said would make access to medical card help “more humane”.

Chief among the moves was a plan to “strengthen” GP rights to veto the removal of a card by reinstating the support for up to a year in some cases if they felt the decision was unfair.

After doctors across all three medical unions raised surprise over claims that they always had this power — which could have prevented the vast majority of card removal scandals in the past 12 months — the HSE said GPs have always had this right.

Backing up the claim, the HSE provided a circular signed by the body and the Irish Medical Organisation’s then chief executive, George McNeice, in February 2012, outlining the measure.

As reported by the Irish Examiner on Thursday, GPs said the claim was “inconceivable” and “straight out of Monty Python”, insisting that they had never been informed of this alleged right throughout the year-long controversy.

After examining the claimed deal in 2012, the NAGP last night released a more detailed statement, saying the two-year-old plan — on which a key part of Mr Varadkar’s reforms is based — is “fundamentally flawed” and does not protect vulnerable patients.

The group said that, despite this week’s claims, the 2012 rule does not allow GPs to reinstate the support when it has already been cancelled. Instead, it said the agreement only allows the restoration of the help when a card is in the process of being cancelled.

Even in this situation, the NAGP said the power is limited to specific, practical issues such as incorrect concerns a person who holds the card has passed away or because correspondence has not been returned, sometimes due to an incorrect address being given.

While the reinstatement right is used roughly 800 times a year, the NAGP said it is aware of countless cases where doctors who tried to restore cards were told this was not possible as the people involved fell outside these categories.

Mr Varadkar has in recent days put forward the GP right as a key part of his 10-point plan to reform the medical card system.

The minister’s spokesperson told this newspaper the veto plan is “already legally sound”, a claim which is now under question, but accepted that new legislation may be needed to adapt the 2012 rule.

The situation emerged as the HSE’s 2015 service plan said 60,000 fewer people will have medical cards next year.

However, while concerns were raised that this could be the first sign of a fresh cull, Mr Varadkar stressed the drop is due to the belief more people will be in work — meaning less cards will be needed.

The service plan, which will see an extra €115m ring-fenced for health services when a €510m overrun is taken into account for 2014, was initially welcomed as the first funding increase for seven years.