If your GP has not mentioned GP referral surgery abroad Ireland and the Cross Border Directive, they are not alone — many Irish GPs are unfamiliar with the process. Here is exactly what to say, and what your GP needs to do.
Step 1: Know What You’re Asking For
You are asking your GP to write a referral letter for hip or knee replacement surgery abroad under the EU Cross Border Directive (CBD). This is a standard GP referral — the same type of letter a GP writes when referring a patient to a consultant. It is not a complex form or an unusual request. Your GP does not need to have prior knowledge of the CBD to write this letter.
Step 2: What the Letter Must Include
For the HSE Cross Border Directive, your GP referral letter needs:
- Your full name, date of birth, and address
- Your GP's name, practice address, and signature
- A brief description of your condition (e.g. osteoarthritis of the right hip)
- A statement that hip or knee replacement surgery is medically necessary
- Confirmation that you are entitled to public healthcare in Ireland
- The name of the hospital or consultant abroad (DHKC can provide this)
We provide your GP with a template letter and a briefing document. Our Irish liaison officer Sarah Hyde can call your GP directly if they would like to speak to someone — this is a free service and many GPs find it helpful.
Step 3: What to Say at Your GP Appointment
Many patients feel nervous about raising surgery abroad with their GP. Here is what works:
"I have been told I need a hip/knee replacement and I'm facing a long wait on the public list. I've been looking into the EU Cross Border Directive, which allows me to get surgery in another EU country and claim the cost back from the HSE. I'd like to get a referral letter so I can proceed. I have a clinic in Amsterdam called DHKC (Dutch Hip and Knee Clinic) who can provide a template if that's helpful."
Most GPs are supportive when patients raise this. The CBD is a patient's legal right under EU law — your GP cannot refuse to write a referral on medical grounds if your condition genuinely requires surgery.
Step 4: If Your GP Is Unsure
Some GPs are simply unfamiliar with the Cross Border Directive. This is common and not a barrier. Give them the HSE Contact Point details:
- HSE Cross Border Directive Office: St Canice's Hospital, Dublin Road, Kilkenny
- Tel: 056 778 4546
- Email: crossborderdirective@hse.ie
Alternatively, ask us to contact your GP directly. Sarah Hyde has spoken to hundreds of GPs across Ireland about the CBD process. It is a 5-minute conversation and most GPs are happy to proceed once they understand the scheme.
You Do Not Need to Be on a Waiting List First
This surprises many patients: you do not need to already be on an HSE waiting list to use the Cross Border Directive. If your GP confirms that surgery is medically necessary and you are entitled to public healthcare, you can proceed. You simply need the referral letter — not a waiting list number.
Ready to Start?
Call Sarah Hyde on 087 002 9686 before your GP appointment. She will prepare a GP briefing pack and template letter so your appointment is as smooth as possible. There is no fee, no commitment, and no paperwork at this stage — just a conversation.
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