GPs must exercise proper care when advising patients about treatment and the material risks and alternatives. Many GPs may be happy to discuss and agree the option of referral abroad with patients but HSE guidelines confirm that there is no obligation on a GP or clinician to refer a patient abroad. For example, a GP could refuse to refer a patient abroad if unfamiliar with or concerned about the quality, safety or appropriateness of the service in question.
When a GP is making a referral, whether it is in Ireland or abroad, they should be satisfied that it is in the patient’s best interests. The GP should be satisfied that the referral and suggested treatment is appropriate and that as far as they can ascertain, the provider to whom they refer is competent and appropriately skilled.
A GP should comply with the current Medical Council guidelines on referrals (see Appendix). The patient must be well informed about the risks of attending medical care in another country and a clear, comprehensive note of the conversation should be kept.
The HSE guidelines make it clear that it falls to the patient or the GP to satisfy him / herself as to the qualifications, suitability and practice rights of the service provider abroad.
If a GP or patient wants information on services or service providers in other EU / EEA States, they can contact the National Contact Point for that other State. Details of the National Contact Points for the other EU/EEA* States are available at: https://ec.europa.eu/health/cross_border_care/docs/cbhc_ncp_en.pdf.
If a patient or GP wishes to query the qualifications, registration, good standing etc of the clinician whom a patient wishes to attend abroad they can email Catherine Donohoe at firstname.lastname@example.org. Queries raised in this way should be specific about the particular information sought and the doctor in question should be specifically identified.
Ms Donohoe will contact the Internal Market Information (IMI) section of the EU and request the clarification needed.
Medisec appreciate that GPs are unlikely to have specific knowledge about healthcare systems or particular healthcare providers abroad. As above, there is no obligation on a GP or clinician to refer a patient abroad. If a GP cannot satisfy himself/herself as to the suitability of a specialist abroad, the GP should inform the patient about the Cross Border Directive and offer to put their patient in contact with the HSE (the National Contact Point for Cross Border Healthcare in Ireland, see Appendix). The HSE will link the patient with the relevant National Contact Point in the other EU country to get the information. This information may include details about which healthcare providers may and may not provide particular treatments, standards to which healthcare providers must conform, and the means of obtaining redress in the event of any harm.
It may therefore fall to the patient to investigate and satisfy themselves as to the care being offered abroad. In this scenario, a GP’s role should be limited to the referral process. Where a GP has already referred a patient to a local public OPD in the Irish system, a waiting list letter or appointment letter from the hospital will also suffice as a referral to help the patient obtain an appointment abroad.
If a GP has specific knowledge about a particular healthcare provider, for example in the UK or Northern Ireland, the GP may refer a patient to such a healthcare provider. As with any referral, the GP should be satisfied that it is in the patient’s best interests, that the suggested treatment is appropriate and insofar as possible, that the provider to whom they refer is competent and appropriately skilled.
Many GPs are concerned about providing follow up care on the patient’s return. Every EU patient is entitled to the same care that they would have in another EU country. If a GP feels that providing follow up care is beyond their expertise the patient should be referred back to the Consultant abroad or to a Consultant in the same medical discipline in Ireland.
Referrals for fertility treatment are not facilitated under the Cross Border Directive and a GP has no involvement in the funding process for applicants.
Medical Council Guidelines 8th Edition 2016
Referral of patients
38.1 It is in the best interests of the patient that the overall management of their health is under the supervision and guidance of a general practitioner.
38.2 If you consider that it is in the best interests of the patient to be referred for specialist opinion, you should consider relevant professional guidelines and refer your patient to a specialist who is competent and appropriately skilled to deal with the particular patient. (See also paragraph 23.)
38.3 Normally, consultants will see patients following referral from their general practitioner, another consultant or treating doctor. In some cases there might be no such referral. In all cases, you should inform the patient’s general practitioner of the patient’s progress, unless the patient specifically objects. (See also paragraph 30.3.)
38.4 You should usually help a patient who requests another opinion unless you judge that this is not in their best interests. You should make copies of all relevant information available to another registered doctor nominated by the patient.
38.5 You must not pay a fee to another practitioner for the referral of patients or accept a fee for making a referral.
23.1 Handover is the transfer of professional responsibility and accountability for some or all aspects of the care of a patient, or group of patients, to another person or professional group on a temporary or permanent basis. You will hand over care when you change shift, refer a patient to secondary care or other health professionals, or when your patient returns to the care of their GP. Handovers may take place between teams and/or between individuals.
30 Disclosure with consent
30.3 Most people understand and accept that information must be shared within the healthcare team and support staff to provide safe and effective care. If disclosure of a patient’s information is necessary as part of their care and treatment, you should disclose the information to an appropriate person and make sure they understand that the information is confidential. You should explain to the patient that information is being shared for their benefit and with whom the information is being shared. If the patient objects to the transfer of information that you consider necessary for the provision of safe care, you should explain that you cannot refer them or arrange their treatment without disclosing that information.
The National Contact Point for Cross Border Healthcare in Ireland National
Postal Contact Point: HSE Cross Border Directive, St Canice’s Hospital, Dublin Road, Kilkenny
Telephone: 056 778 4547 or 056 778 4546 or 056 778 4556
“The contents of this publication are indicative of current developments and contain guidance on general medico legal queries. It does not constitute and should not be relied upon as definitive legal, clinical or other advice and if you have any specific queries, please contact Medisec for advice.”