Jan O'Sullivan (Limerick City, Labour)

The Medical Council's guide to professional conduct and ethics states that "it is in the best interests of the patient that a general practitioner, GP, supervises and guides the overall management of their health". There are approximately 2,600 GPs in active practice, of which approximately 2,300 hold a contract with the Health Service Executive, HSE, for the provision of services under the general medical services, GMS, scheme to medical card and GP visit card patients. Approximately 40% of the population is covered by the GMS scheme. GMS contracted GPs undertake to provide their patients with all proper and necessary treatment of a kind generally undertaken by a GP. That includes the issuing of a prescription for medicines or drugs as is determined to be necessary by the GP for his or her patient.

Since 1996 there has been an arrangement under the GMS scheme for the emergency supply of medicines for medical card holders on discharge from hospital. Community pharmacists participating in the GMS scheme are authorised to dispense a maximum of seven days' supply of medicines prescribed for persons who have been inpatients in a hospital or who have attended an accident and emergency department and because of the circumstances of their discharge and-or the urgency of the prescribed medication it would not be possible to attend their general practitioners to have the hospital prescription transcribed to a GMS prescription form. This arrangement relieves any difficulties that patients might encounter who are due to be discharged from hospital late in the evening or at weekends.

I believe that the Deputy is raising this matter, as he indicated, in the context of recent changes to the supply of medicines to some mental health patients in the area of the former Eastern Regional Health Authority. In line with the Health Service Executive's stated policy to standardise and streamline arrangements under the State drug schemes, to improve equity for service users and increase efficiency, local services have been advised to direct medical card holders requiring psychiatric medicines to attend their local general practitioner. This approach aligns the arrangements for the dispensing of drugs and medicines to persons on medication for a mental health condition, who reside in the greater Dublin area, with the arrangements that pertain in the case of persons living in all other parts of the country. This is also consistent with the arrangements for dispensing drugs and medicines across the full spectrum of medical conditions and is consistent with the policy of normalising and de-stigmatising this aspect of our health care service. It is also consistent with the key recommendations in A Vision For Change, the report of the expert group on mental health policy, pertaining to the treatment and care of mental health conditions in the primary care setting where it is acknowledged that treatment in this setting "enables the largest number of people to get easier and faster access to services".

This initiative ensures that general practitioners have a full involvement in their client's medications, including their psychiatric drugs. The process also ensures that pharmacists, who continue to provide this medication to eligible persons under the various scheme arrangements, can claim reimbursement in respect of these drugs with their other monthly submissions. These claims will be reimbursed by the HSE at the tariffs set by the Minister for Health under the applicable regulations. This change will not disadvantage medical card holders and it will reduce the administration associated with these arrangements and free up resources for other patient services.

In summary, I assure the Deputy that it is best clinical practice that a person in need of treatment should regularly attend their GP and that the GP is fully aware of the medications that any patient may be being prescribed. This is entirely consistent with the gatekeeper role played by the GP in the delivery of primary care. Furthermore, due to the reimbursement arrangements under the GMS scheme whereby a GP is paid a capitation fee per eligible patient on their list, there are no additional costs associated with an eligible patient attending. Rather, the rationalisation of previous local arrangements to fit with the national arrangements provides obvious administrative savings and increased efficiencies.

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