Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail) | Oireachtas source

I have told several Ministers about the state of services for medical cardholders and working people with PRSI contributions. Dental services for medical cardholders are already under significant pressure in all areas. I am now seeing a worrying development that causes me to question the model of contract used.

I am acutely aware of the pressure on dental services for medical cardholders in Carlow because I have been on the phone to dentists in my area asking for help with emergencies and severe cases. Subsidised dental services are currently available to medical cardholders and to qualifying workers who pay PRSI contributions but these services and general medical card and dental services are under significant threat from a recent audit decision by Revenue.

The traditional dental model operating in Ireland, the UK and Europe is that self-employed dentists, known as dental associates, who practise as a joint venture within a group, hold individual contracts with the Department of Health and the Department of Social Protection to provide a range of dental services to the general public on a fee-per-item basis. The contracts are specifically stated contracts for service and are exclusively stated for self-employed contracts.

I am assisting a group operating in Carlow which is concerned about these contracts. The contracts have been in operation and unchanged since 1993, which is almost 30 years ago. They cannot be subcontracted. Dentists who are employees cannot hold or operate these contracts legally in this manner. A recent Revenue decision to categorise these dental associates as employees in a practice in Carlow means the contract with the Department will be illegal. These dentists have paid their own taxes in order to continually hold the dental contracts. Each contract holder must produce an annual tax clearance certificate to the Department that offers the contracts to the dentist. However, Revenue has decided some self-employed dental associates are actually employees and this impacts the group operator, which has now been told these dentists are employees and not self-employed.

Revenue recently decided to recognise the traditional dental model of dental associates, which is dental principal, to be a joint venture with no VAT liability, yet Revenue is now raising assessments against group operators for PAYE and PRSI obligations that should not be there. If Revenue presses the status of dental associates as that of an employee, some dental associates in Ireland will have to resign their current contracts for service with the HSE and the Department of Social Protection, and will not be able to see patients under these schemes. This will lead to an increased crisis of access in the provision of dental services for medical cardholders and also access for PRSI contributors.

Will the Department for Social Protection revisit the current model or impress upon the Department of Finance the need to standardise the approach to the self-employed status of dental associates? As it currently stands, Revenue has opposing views on the matter in two Departments. Audit is one and VAT is the other. If dental associates are pressed to drop services for the PRSI medical cardholders, the loss to the community will be enormous. The Minister of State knows how important these services are. I urge her to speak to officials in the Department of Health and the Department of Finance to regularise the situation to prevent the loss of service to the public.

This matter was brought to my attention by some dentists in Carlow. I want clarification. The biggest issue is that this has not been reviewed in nearly 30 years. We must ensure that medical card patients get to go to the dentist. That is what the system is there for.

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