Dominic Hannigan (Meath East, Labour)
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I thank the Ceann Comhairle's office for giving me the opportunity to raise the issue and I thank the Minister of State, Deputy Shortall, for taking the matter.

The charging of medical cardholders for blood tests was raised with me just after the general election in February. A couple were asked to pay for a blood test even though they were in possession of a valid medical card. Of course they paid because they were worried about their health and felt that failure to pay would result in failure to have a test, resulting in the illness going undiagnosed or untreated. They were confused and decided to pay as of course they would.

They worried about how they could afford it and whether this was just the start of a creeping system whereby they would pay for more and more services while at the same time being in possession of a medical card. I know they were not the only couple as others across County Meath have contacted me, and I believe it is common in other counties for GPs to charge people for taking blood, even though those people have medical cards.

At present, one in every three people in the country has a medical card or a GP card, and this number has been increasing since the start of the recession. The HSE's figures suggest that by the end of this year up to 40% of the population will be in receipt of a medical card. The overall cost of the GMS scheme to the Exchequer was just under €2 billion in 2009 and payments to GPs under the scheme total approximately €500 million every year. Some 2,100 GPs are in receipt of a GMS contract and the average payment to each of them is approximately €225,000. Payments vary throughout the country but, of course, on top of those payments GPs are also entitled to take on private clients, so the total payments going into a GP's practice could typically be of the order of €400,000 to €500,000 per year.

There was an 8% cut to the payment a couple of years ago and the Irish Medical Organisation argues that this makes it more difficult for GPs to provide services. However, not one GP has opted out of the GMS contract so, clearly, it is not that difficult to cater for the 8% cut. It is intolerable and unfair that GPs are asking vulnerable people to pay a blood test charge, which is a direct attack on poor people. Personally, I am disgusted any doctor would do this.

I am glad to see the Minister of State, Deputy Shortall, in the House. We need to have clarity on this issue so I ask the Minister of State to outline the situation and clarify whether GPs have the right to charge people with medical cards for blood tests, what they can charge for and whether the Minister will be issuing guidance in this regard so we can clear up the matter once and for all.

Róisín Shortall (Dublin North West, Labour)
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I thank Deputy Hannigan for raising this matter. I know it is an issue he has been concerned about for some time and he first raised it with me shortly after being elected to this House. I am glad to have the opportunity to provide clarification on the matter. A number of other Deputies have raised it in parliamentary questions also, so it is important we get this clarification.

Under the General Medical Services contract, a general practitioner is expected to provide his or her patients who hold a medical card or a GP visit card with all proper and necessary treatment of a kind generally undertaken by a GP. Where blood tests form part of the investigation and necessary treatment of patients' symptoms or conditions, these should be provided free of charge to medical card and GP visit card holders.

The HSE also points out that in many GP surgeries it is the practice nurse who takes blood samples. The HSE significantly subsidises the cost of employing practice nurses. In fact, last year the executive provided €39 million in allowances to GMS GPs in this regard.

There are almost 2,300 GPs contracted by the HSE to provide GP services under the GMS scheme to more than 1.6 million medical card holders and 120,000 GP visit card holders. As Deputy Hannigan pointed out, GPs within the GMS receive payments up to approximately €500 million in this regard. The HSE has recently reported to my Department that it has received approximately 30 formal complaints from GMS patients regarding GPs charging for blood tests and there have also been a significant number of queries to the HSE's national information line about this issue. Formal complaints will be dealt with through the HSE's consumer affairs service.

The GMS contract prohibits GPs seeking or accepting payment from patients for the provision of services under the contract. I am disappointed that a minority of GPs have disregarded this provision and have chosen to charge patients whom the State has deemed to be unable to meet the cost of medical services. As Deputy Hannigan said, these are the most vulnerable people. At my request, the HSE has recently written to all GMS GPs reminding them of their obligations under their contract. I will be monitoring the situation closely to ensure this unacceptable practice is brought to an end. In the meantime, public patients should contact the HSE if they believe they are being wrongly charged for services by their GP and the matter will be appropriately investigated.

I appreciate that because of the nature of the GP-patient relationship, it may be difficult for patients to make such complaints. Where public representatives are made aware of GPs charging GMS patients for blood tests, they may wish to notify the HSE directly.

I thank the Deputy for raising this matter. I assure him of my determination to address the issue and bring an end to this practice.