Róisín Shortall (Dublin North West, Labour)

I thank the Deputy for raising this issue because it has come up from time to time in the last year in the House. I am glad to have the opportunity to clarify the position on it.

The current general medical services GP capitation contract was introduced in 1989 and is based on a diagnosis and treatment model. Section 11 of the contract provides that the medical practitioner shall provide for eligible persons, on behalf of the Health Service Executive, all proper and necessary treatment of a kind usually undertaken by a general practitioner and not requiring special skill or experience of a degree or kind which general practitioners cannot reasonably be expected to possess. GPs who hold GMS contracts with the HSE must not seek or accept money from medical card or GP visit card holders for services covered under the GMS contract. In circumstances where the taking of blood is necessary either to assist in the process of diagnosing a patient, or monitor a diagnosed condition, the GP may not charge the patient if he or she is eligible for free GMS services. I am very disappointed that a minority of GPs have chosen to charge patients whom the State has deemed to be unable to meet the cost of medical services.

This issue was first raised last year. At my request, the HSE wrote to all GMS GPs on 21 June 2011, reminding them of their obligations under their contract in respect of services such as phlebotomy and advised them that charges should not be applied for such services. The HSE also pointed out that in many GP surgeries it was the practice nurse who took blood samples and that the HSE significantly subsidised the cost of employing such practice nurses. I will continue to monitor the situation closely to ensure this unacceptable practice is brought to an end.

The HSE is encouraging eligible patients who believe they have been inappropriately charged by a GP for routine phlebotomy services to seek a refund from the GP in question. Alternatively, they may wish to follow up with the HSE and the matter will be fully investigated. Formal complaints will be dealt with through the HSE's consumer affairs service. In a number of cases to date GPs have reimbursed their patients following receipt of correspondence from the HSE. It is appreciated that because of the nature of the GP-patient relationship, it may be difficult for patients to make such complaints. I fully appreciate this. Where public representatives are made aware of GPs charging GMS patients in error, they may wish to notify the HSE directly.

It is worth reiterating that the programme for Government provides for the introduction of a new GMS contract, with an increased emphasis on the management of chronic conditions such as diabetes and cardiovascular conditions. It is envisaged that the new contract, when finalised, will focus on prevention and include a requirement for GPs to provide care as part of integrated multidisciplinary primary care teams. Officials in my Department are in consultations with the HSE with a view to drawing up a new contract. The appropriate arrangements for phlebotomy services will be considered as part of the new contract. I again thank the Deputy for raising the matter.

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