The circumstances in which a general practitioner can refuse to register a Traveller patient are to be limited in future.
The plan is part of a range of initiatives contained in a Department of Health document being publish- ed today which aims to improve the health status of the State's estimated 26,400 Travellers.
The National Traveller Health Strategy 2002-2005, which has been seen by The Irish Times, states that Ireland's Traveller population has experienced a level of health which falls far short of that enjoyed by the general population.
It says Travellers die younger, their take-up of immunisations is low, and their utilisation of ante-natal and post-natal care is poor.
The strategy, which is to be implemented by 2005, refers to research which found 17 per cent of Travellers had experienced difficulty registering with a GP. "In many areas it was found that only a small number of GPs provided services to Travellers."
Acting on this, the strategy proposes that any future General Medical Services (GMS) scheme contracts issued to doctors "will be expressed so as to limit the circumstances in which a GP who is a contracted GMS scheme doctor can refuse to register a Traveller patient". The limitation will also be inserted in contracts which are reviewed.
Under the strategy, health boards, in liaison with Traveller representative organisations, will also be required to monitor access by Travellers to GP services on a regular basis and will have to report annually on "developments and progress in this regard".
It is also planned to introduce a system of patient-held records for use by Traveller families by June 2003. These may contain information on a patient's medical history including all GP and hospital consultations.
The strategy notes that many Traveller men rarely attend a GP, sending their wives instead to renew prescriptions. Now, the prescribing practices used by GPs for the Traveller community are to be reviewed, and this review must be complete within a year.
The strategy states that recent unpublished research on Travellers in hospital by the Eastern Region Traveller Health Unit showed there was a negligible referral rate by GPs to outpatient departments.
"This gives rise to a situation where Travellers use A&E services as this is the only way they can access a hospital bed or an outpatient clinic," it said.
The document acknowledges that the health services have responded in "a fragmented and often inappropriate manner" to the special needs of Travellers in the past. "This has been compounded by a lack of awareness among Travellers of the value of preventive services in particular," it said.
To combat these problems it proposes training and education for healthcare staff in intercultural and anti-discrimination practices and in particular Traveller perspectives on health and illness.
It also states that much of the data on the status of the health of the Traveller population are not up to date and that a Traveller needs assessment and a health status study to be carried out urgently. It notes, however, that the life expectancy of Traveller women in the 1980s was found to be 12 years less than the population as a whole, and for Traveller men 10 years less than the general population. "It is reasonable to assume that there has been little, if any, improvement since then."
Last night the National Traveller Women's Forum said it was vital the strategy was backed by the resources needed to see it fully implemented.