Dr. Mary Favier:

It is well established that all female patients consult their doctor more often than men, whether because of their own health issues or because they bring children and other family members to the doctor.

That is particularly true in the Traveller community because there are particular cultural barriers for Traveller men accessing the services. It is an issue of which we must be aware. Those barriers can range from sitting in the waiting room through to, for example, presenting to younger female doctors. Those are cultural issues and it is for us, as GPs, to be aware of those issues, attempt to circumvent them and understand cultural issues around not wishing to present with mental health issues, for instance.

We have recently rolled out a suicide prevention training programme that has involved almost 500 GPs and a particular part of that relates to the increased risk of suicide in the Traveller community and the issues for men presenting with mental health problems.

The access to services and educational opportunities for women in the Traveller community have come on extraordinarily in the past 20 years. There has been a massive change and Traveller men are only starting to catch up from a health point of view, which is to be welcomed.

Bureaucracy issues fall disproportionately on the women because they often have to deal with trying to sort out all the medical cards and keep on the top of the paperwork and appointments. As GPs, we would value clarification on the medical card issues because patients can present with a valid, brand new plastic card that is not valid. Practices such as ours are long established and we know the patients well so there are many workarounds but in out-of-hours and GP on-call services, that is a fundamental problem. Situations arise where there are tensions around patients presenting without cards, who has a card and who does not, and whether a card is valid. It needs to be sorted out.

The bureaucracy issues apply on so many levels in respect of literacy. There is a need for cultural awareness that form filling should not be done just for the sake of it. The centralisation of services to what we call the offices off the M50 has proved problematic for patients and is challenging for GPs. We meet significant literacy skill issues in the area of health bureaucracy. There are problems that could be quickly solved, which would make everybody happier.