Tuesday, 3 December 2013
Topical Issue Debate
General Practitioner Services
I thank the Ceann Comhairle for allowing me to raise this matter. This is not the first occasion on which I have raised the issue of GPs charging medical card holders for service to which, I understood, they were entitled free of charge. In July 2011, I brought to the attention of the House the fact that some GPs were charging medical card holders for blood tests. At that time I received a strong commitment from the Minister of State's predecessor to the effect that the Department would ensure that any GP charging medical card holders for blood tests would be investigated. I understand the Department also wrote letters to all GPs advising them that blood tests are covered under the General Medical Services, GMS, contract. I am now seeking clarification from the Minister of State in respect of another service GPs provide to their patients which, I also understand, is covered under that contract.
I recently met one of my constituents from County Meath who has mobility issues. As a result, she is obliged to use a mobility scooter. She lives in a House that is not suited to her needs or to the use of said scooter. This makes it difficult for her to enjoy a good quality of life in her own home. The woman in question does not have the money to have her house refurbished so she has applied to Meath County Council for a house that would be more suited to her needs. The housing section of the council is helping the woman to find a new home. However, in accordance with the rules under which the latter operates, she was obliged to obtain a letter from her GP outlining her medical condition and the impact living in her current home is having on that condition. The woman concerned went to her local GP and obtained the following letter. Obviously, I will not read the names of either the woman or her GP into the record. The letter states:
To whom it may concernThat is great and it is just what the council wanted. However, the woman - who is in her 70s and who has a medical card - was presented with a bill for €50 in respect of the letter, which contains only nine sentences. This is simply astonishing. It is not unusual for GPs to be asked to provide letters outlining the nature of people's illnesses to councils or other State bodies. These are very routine requests.
This is to certify that the above mentioned is under our care. She has background history of osteoporosis and degenerative bone disease. She needs constant medical care and attention. She has recently been recommended use of a mobility scooter by the HSE's services which enables her to mobilise for longer distances. She also needs to have modifications made in her home, such as railings and ramps, to enable her to move more easily within her home environment.
I feel these adjustments would be of huge benefit to this lady with her disabling conditions. I would be grateful if you would take this into consideration on her application for housing. Many thanks for your help in this matter.
With respect, this is happening on the Minister of State's watch. That to which I refer is unacceptable and we need to do something about it. I ask the Minister of State to clarify whether there are circumstances in which GPs can charge medical card holders for services. If not, will he advise as to how this woman and others who have been asked to pay for the routine service to which I refer can obtain refunds? Will he also make it clear to GPs that this type of behaviour is not acceptable?
It might be useful to quote the relevant section of the GMS contract. In that regard, section 11 states:
The medical practitioner shall provide for eligible persons, on behalf of the relevant Health Board, 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.In the context of the issue raised by the Deputy, the section also states:
The medical practitioner shall:...furnish to a person whom he has examined and for whom he is obliged to provide services (or, in the case of a child, to his parent) a certificate in relation, to any illness noticed during the examination which is reasonably required by him or by the parent as the case may be. Such examinations as the doctor may carry out on a patient prior to the issue to him of first and final Social Welfare certificates are comprehended by the capitation payments. Payment under this contract is not made in respect of certain other certificates required, e.g. under the Social Welfare Acts or for the purposes of insurance or assurance policies or for the issue of driving licenses.Under paragraph 27 of the GMS contract, a medical practitioner shall not demand or accept any payment or consideration from a GMS patient for services provided by him or her which are covered by the contract. Any alleged instances of eligible patients being requested to pay for a service covered by the contract, such as the provision of a sick certificate as outlined in the quotation, is viewed as a serious matter by the HSE and the Department. The HSE's local health offices will fully investigate any reported incidents of eligible patients being charged for services covered by the GMS contract.
The Deputy may also wish to note that the Department of Social Protection pays fees to medical certifiers, who are mainly general practitioners, for the completion and issue of medical certificates for illness benefit and the completion of medical reports for various social welfare schemes. The fees are paid for the provision of medical opinion which is furnished on an official certificate or report form. Consultation fees charged by general practitioners to private patients and to GMS patients outside the terms of the GMS contract are a matter of private contract between the clinicians and the patients. While I have no role in respect of such fees, I would expect clinicians to have regard to the overall economic situation in setting them.
I thank the Minister of State for his reply, in which he set out the position very clearly. He stated that a medical practitioner shall furnish to a person services which are reasonably required by him or her. Does this revolve around what is deemed to be reasonable and what is not? I am of the view that it is very reasonable to provide to someone with osteoporosis and a degenerative bone disease - and who, under the contract, is eligible to avail of such a service free of charge - the required letter. It is clear that this is a case where the GP acted outside the terms of the contract. If I furnish the name of the GP involved, can I expect that the Department will take the necessary action?
I cannot comment specifically on an individual case. I can, however, assure the Deputy that there are certain types of letters and certificates which are comprehended by the contract and in respect of which fees should not be sought or charged. The Deputy was correct to focus on the use of the term "examination which is reasonably required" in the contract in the context of the certificate or letter to which he refers. It might be advisable to consider raising this matter with the HSE's local health office in respect of any investigation he might consider appropriate in this case. If he requires my assistance in that regard or in respect of progressing matters further, I will be more than willing to provide it.