DOCTORS say they may be forced to charge women who have recovered from breast cancer who are referred to them for follow-up care.
Around 2,000 women who have been given the all-clear for the disease will be sent to their GP rather than back to specialists in the future.
They will still be offered a free X-ray every year, but will have their general examination carried out by GPs, under the proposals from the HSE National Cancer Care Programme (NCCP).
However, Dr Ray Walley, chairman of the GP committee in the Irish Medical Organisation (IMO), said this would mean an extra workload for GPs and those with a medical card may have to be charged.
"The HSE is failing to fund or invest in cancer-care services in general practice, thereby passing all costs on to patients, including medical-card patients.
"Patients need to be aware that this decision taken by the HSE means patients will carry the cost of their cancer care. This is wholly unacceptable."
"While the IMO welcomes, in principal, plans to transfer secondary-care workload to general practice, the method by which the NCCP has gone about implementing it falls short of ensuring it is being done in a planned manner with the provision of appropriate resources and funding to ensure equitable availability of care nationwide."
He added: "We believe there are significant patient care and safety implications as the responsibilities placed on GPs by the guidance document will have major resource implications.
"In the absence of appropriate planning and the required resources, GPs may not be in a position to provide appropriate follow-up care with potentially serious implications for patient care."
However, Dr Marie Laffoy, community oncology adviser to the NCCP, said the examination would be a routine check-up and GPs would only expect to see a handful of these patients annually.
"There is a growing body of evidence internationally that long-term, hospital-based clinical follow-up of well women with a history of breast cancer is not required and confers no additional benefit to the women.
"The NCCP has developed a follow-up care plan for patients who have been discharged from outpatient clinics following their treatment for breast cancer.
"This follow-up care plan is evidence-based and follows best international practice.
"This plan is aimed at patients who have completed their treatment, who are well, have had no recurrence after five years and continue to have a good outcome.
"Any woman who needs to be treated on an acute basis is cared for appropriately and timely under the management of her consultant team," she added.
In reference to the charging of medical patients, the NCCP said it did not deal with contract issues.