A leading HSE official has admitted that the recent removal of discretionary medical cards from some patients was 'indefensible' and says he believes the current medical card eligibility system should be replaced.

John Hennessy, the HSE's National Director of Primary Care, was speaking at the annual conference of the Irish College of General Practitioners (ICGP) in Galway.

In response to queries from the floor from GPs about needy patients who had had their medical cards removed, Mr Hennessy said medical card eligibility was a difficult issue and it if was easy it would have been fixed a long time ago.

"There are some things that have happened that are clearly indefensible," Mr Hennessy admitted, adding that this type of situation should not be allowed occur in future.

Mr Hennessy told the conference he believed that the system of assessing eligibility for medical cards was outdated, and it was high time it was replaced.

Bray Co. Wicklow GP Dr Rita Doyle, whose disabled patient was the subject of a discretionary medical card removal recently highlighted in the media, told the meeting that the removal of these cards was 'single most evil thing our society is standing over'.

She said if the discretionary medical card issue was not sorted out she would have no stomach for taking part in the planned free GP care scheme for children under six.

Mr Hennessy commented that this case was an example of 'how we should not be doing things'

"We need a different scheme, he said.

Dr Declan Larkin, a GP from Galway, told the ICGP meeting his medical card patient list had been reduced from 800 down to 600.

Mr Hennessy pointed out that there was considerable variation in the issuing of discretionary cards from county to county. It varied from five per 1,000 population to 50 per 1,000 between some counties.

He said he had no interest in a 'two or three tier health system', but in a good quality service.

He said the currrent medical card scheme was not fit for purpose and a new one was needed. He suggested that the future provision of universal access to GP care could provide a solution.

Health Minister James Reilly recently announced that in the wake of the controversy over the removal of medical cards from vulnerable people, the possibility of having a 'third tier' of medical card was being looked at.

The Galway meeting also reiterated concerns among GPs about the Government's plans for the under sixes scheme, and in particular about the draft contract for the scheme, which they say is unworkable.

Cork GP Dr Brian Coffey told the meeting that the contract, which was presented to GP groups at a meeting earlier this year, had antagonised GPs and had united then as never before in opposition to it. He said the contract should be taken back and started on again, and should not be negotiated in its current form.

Mr Hennessy, in response, said it may have been better in hindsight to have appeared at the table with no draft contract document initially, but the decision was made at the time to produce the document.

GPs at the meeting also claimed that a 'gagging clause' in the contract would prevent doctors advocating for their patients and speaking out on health service deficiencies.

Dr Ilona Duffy from Co.Monaghan said hospital consultants under their contracts had been censured and penalised for speaking out on behalf of their patients.

Mr Hennessy disagreed, stating that if this really was the case, such a gagging clause had not worked very well on consultants. He said he had never known of a consultant who had been challenged or disciplined in any way in relation to comments they had made.

He said the relevant clause in the draft GP contract was never intended to prevent GPs advocating on behalf of their patients. "If it (the clause) needs an amendment to reflect that I would not see that as a problem."

Mr Hennessy admitted there had not been enough dialogue between health management and GPs and as a result there had been mutual distrust of the respective motives of both sides.

He hoped that dialogue could now take place in a productive way.

"Talks about talks' between the doctors' union, the IMO, and Minister for Primary Care Alex White on the under sixes proposals were held on Friday and are set to resume later this week.