in-cyprus 21 October 2025 - by Marilena Panayi
Personal doctors (for both children and adults) in the General Health System appear to be exploiting a legal loophole to extend their list beyond the 2,500 beneficiaries they are entitled to have registered as per the legislation.
As a result, as stated during yesterday’s meeting of the parliamentary Human Rights Committee, doctors are handling an excessively heavy workload, effectively monitoring over 3,000-4,000 patients, potentially failing to properly fulfil their duties and putting citizens’ health at risk.
It was also discovered during the meeting that some of these doctors permanently present themselves as “substitutes” for colleagues, transferring beneficiaries they monitor to these colleagues’ lists, which constitutes an abuse of the substitution right granted by the General Health System.
The disclosure of a case where parents reported to the Health Insurance Organisation (HIO) that their children were never registered on their personal paediatrician’s list, despite being monitored by him since birth, appears to have alarmed the Organisation.
General Director Ifigenia Kammitsi yesterday informed the parliamentary committee that legislative changes are being promoted to close the gap and correct this distortion.
As the parents explained during the meeting, their children have been monitored by a specific paediatrician since birth. With the implementation of GHS, they naturally chose this doctor to register their children on his list.
When their daughter began showing various symptoms, they communicated with the doctor who, they claimed, gave them instructions over the phone, or they sent photos of the child, with the doctor reassuring them it was nothing serious.
“As a result, some time later our daughter was diagnosed with cancer at an advanced stage,” said the father, arguing that “this didn’t happen because the paediatrician isn’t a good doctor—on the contrary—but because the doctor has so many children to monitor that he can’t properly meet his obligations”.
After the incident, the parents decided to change paediatricians and discovered that their children were registered on another doctor’s list, whom their doctor was “substituting” for under a relevant GHS provision.
They filed a complaint with the HIO (a year and a half ago), without, however, having received any response to date, they said.
Committee Chairwoman Irene Charalambidou also approached the HIO regarding this specific case eight months ago, as she mentioned, again without receiving answers.
“This is why we are discussing this issue today, because we need to see where this right of substitution for GHS personal doctors begins and ends,” she said in her statement.
The father also mentioned that due to his daughter’s illness, he discovered that in her GHS file, there were referrals recorded for various examinations from the paediatrician who was actually monitoring her, with no entries whatsoever from the paediatrician with whom his child was registered.
He also noted that for six months, from September 2023, more than six visits to the substitute doctor had been recorded in the GHS and expressed surprise that the System had not identified anything unusual about this.
“A doctor is not allowed to be permanently substituting for another doctor”
The HIO General Director, Ifigenia Kammitsi, responding to the statements from the parents of the girl eventually diagnosed with cancer, explained that the doctor substitution process is permitted and aims to cover patients when their personal doctor is absent.
She added that emergency doctors operate under the same mechanism, with access to medical files to monitor patients in emergencies, noting that polyclinics function the same way.
Kammitsi admitted, however, that this process was not established or implemented in a way that allows permanent substitution between doctors.
“It is not permitted,” she said, “for a doctor to be permanently substituting for another doctor, and especially, a doctor is not allowed to monitor patients as a substitute” because they have reached the 2,500 patient limit prescribed by law.
“Permanent substitution violates the spirit and philosophy of the personal doctor,” emphasised the HIO General Director.
Because, as she said, there appears to be a gap that might lead to abuse, the HIO intends to revise the entire process to clarify the “temporary” nature of substitutions.
However, the changes to be made, she said, “will certainly not prohibit substitution because this operates to the benefit of patients and will certainly not affect the smooth operation of polyclinics, which also serve patients”.
Responding to complaints from the parents and the Committee Chairwoman about the fact that a complaint was submitted in 2024 and still no response has been given by the HIO, Kammitsi stated that “the HIO has received the doctor’s positions and will forward the appropriate responses both to the family and to the Committee Chairwoman”.
The Patient’s Advocate, Marios Charalambides, stressed that the substitution issue “doesn’t simply end with informing patients that a doctor’s list is full and they will be registered on another doctor’s list but will be monitored by the doctor of their choice. There is also an issue of explaining this function, as well as the prerequisites and consequences of patient consent,” said Charalambides.
The President of the Cyprus Paediatric Society, Michalis Anastasiades, stated that the substitution system serves patients and noted that the process needs regulation.
The President of the Scientific Society of Personal and Family Doctors, Mary Avraamidou, called on those involved to focus on the gaps and misinterpretations and to proceed with necessary corrections but without, she said, abolishing the substitution process.
Both doctors emphasised that telephone communication with patients should be for specific reasons and certainly not for diagnostic purposes.
Doctors officially informed of changes
Last Friday, the HIO sent an announcement to all GHS personal doctors, emphasising that substitution should not be permanent but temporary in nature.
Substitution, as the HIO points out, is allowed only on a temporary basis and not as a permanent practice, as any systematic use of it goes against the philosophy and architecture of the GHS.
The process applies exclusively in cases where the provision of services by the treating physician is temporarily impossible. The Organisation announces that the substitution process is under review, aimed at improving and ensuring the smooth operation of the System.
