Medical card patients who have undergone breast cancer treatment in hospital may have to pay the cost of their GP cancer care follow-up.
It is due to a dispute between the Irish Medical Organisation and the Health Service Executive.
The IMO has warned that GPs will be unable to provide follow-up care for women with a medical card who have undergone treatment for breast cancer without proper funding under a new plan from the HSE.
IMO GP Chairman Dr Ray Walley said patients need to be aware that the decision taken by the HSE means these patients will have to pay the cost of their GP cancer care, which he said was unacceptable.
Responding to the IMO claim, the HSE's national cancer control programme said its GP follow-up plan is aimed at women who have completed their treatment.
The HSE said the follow up plan is aimed at women who are well, have had no recurrence of breast cancer after five years and who continue to have a good outcome.
Women will be seen by their GP when they are well, instead of seeing a consultant, the HSE said.
It said the follow-up plan involves women having an annual mammogram, which will be reviewed by a radiologist, and the results will be sent to their GP.
According to the HSE, international evidence shows that long-term hospital-based clinical follow-up of women with a history of breast cancer is not needed and confers no extra benefit.
The NCCP said it is in continuing correspondence with the IMO, but that GP contract issues are not an issue for it.
In its statement, the IMO said the NCCP had issued a follow-up care plan to individual GPs without formal discussions, which was "surprising and unacceptable" and it has expressed deep concern about the move.
The union said there is no contractual requirement on GPs to provide this cancer care follow-up service at a time when doctors are already struggling to maintain existing levels of service.
The IMO said that while it welcomed in principle plans to transfer hospital care work to general practice, the HSE was failing to fund or invest in cancer care services in general practice.
The IMO said that as a result was passing all costs onto patients, including medical card patients.
Dr Walley said that for such a service to work properly, a GP would have to establish an effective screening service appointment with protected time and access to a chaperone.
The IMO said that over the last four years, €124m has been taken off the GP medical card scheme budget.
It has sought an urgent meeting with the HSE's national cancer care programme to discuss the issue as it cannot accept the proposed plan.
The HSE said that its breast cancer follow-up GP care plan would not involve a major increase in workload for family doctors.
It estimates the numbers at fewer than ten patients per GP per year.