Denise Mitchell (Dublin Bay North, Sinn Fein)
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35. To ask the Minister for Health the action that will be taken by the HSE to address a now common practice whereby general practitioners are charging GMS patients for diagnostic and routine blood tests; the recourse, other than making a complaint, available to patients that have been charged by their general practitioner for blood tests when they are needed; the way a refund can be sought; the action he will take with general practitioners to overcome this issue and barriers to care; and if he will make a statement on the matter. [4560/17]

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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The question is self-explanatory. It refers to the practice of general practitioners charging patients covered by the general medical services, GMS, scheme for blood tests. The Minister accepted in reply to a previous question I asked that general practitioners should not charge for these tests. I am interested in hearing what precisely he proposes to do to stop this practice.

Simon Harris (Wicklow, Fine Gael)
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I thank Deputies Louise O'Reilly and Denise Mitchell for asking this question. There is no provision under the general practice general medical services contract for persons who hold a medical card or general practitioner visit card to be charged for routine phlebotomy services provided by their GP or a practice nurse on behalf of a GP, which are required to either assist in the diagnosis of illness or the treatment of a condition. The HSE has advised general practitioners that where a blood test forms part of the investigation or necessary treatment of a patient’s symptoms or conditions, this should be free of charge for patients who hold a medical card or GP visit card.

Notwithstanding this, I understand that in recent times some GPs have been charging GMS patients for these services. If a patient who holds a medical card or a GP visit card believes that he or she has been incorrectly charged for routine phlebotomy services by his or her GP that patient may make a complaint to the HSE local health office and it will deal with the matter in accordance with the complaints policy.

To achieve clarity on this issue, I have asked that any difference of perspective in regard to the provision of phlebotomy services be addressed in the GP contractual review process. I am pleased that initial meetings with GP representative bodies to progress this work have recently taken place and I look forward to constructive and positive further engagements. From my perspective, the rules under the existing contract are very clear - a GP should not be charging a medical card or GP visit card patient for such blood tests. The HSE's position is that in circumstances where the taking of blood is necessary to either assist in diagnosing or to monitor a diagnosed condition the GP may not charge a patient if he or she is eligible for free GMS services under the Health Act 1970. I understand this position is not accepted by GP representative bodies. To deal with GMS patient complaints regarding charges for phlebotomy services the HSE has put in place an arrangement whereby on receipt of a complaint from a patient or other representative or advocate it imposes a deduction on a GP's practice support subsidy payment and issues the patient a refund of the amount he or she has been charged by the GP for routine phlebotomy. The matter is further complicated by the fact that precise distinctions need to be made between what are deemed routine versus non-routine phlebotomy services. I do not have time to elaborate on that point but there is a difference between the two services.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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The Minister said that this matter will be addressed as part of the GP contract negotiations. One wonders what is the point of the negotiations if GPs are not adhering to the current agreement. I would like to draw the attention of the Minister to the following matter. Many GP surgeries, including some in my own constituency, have put up signs advising patients that if they do not want to pay for their blood tests they can go to the hospital to have them done there. We have just spent a good deal of time discussing the pressures under which our hospitals are already operating. It strikes me that something more concrete can be done. Perhaps a message could be issued to GPs advising them that this is not an acceptable practice. We have already discussed the subventions which GPs receive on a weekly and annual basis. It should not be beyond the scope of the Department of Health to put an end to this practice once and for all.

Simon Harris (Wicklow, Fine Gael)
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I have already outlined what the HSE will do. In other words, if a constituent of the Deputy or of any other Deputy is charged incorrectly for a service that my Department and the HSE believe is covered under the current GMS contract he or she, or another person on his or her behalf, can make a complaint in that regard to the HSE and it will impose a deduction on the GP's practice support subsidy payment and, more importantly from the patient's perspective, will refund the amount he or she has been charged by the GP for routine phlebotomy services. There is no point pretending - there is a long history and record of disagreement on this issue between health service management and GP representative bodies. It is not for me to speak for either of them but I am aware that in their communications to their members they have asserted a different position. The best place to resolve this disagreement and difference of view is around the table through contract negotiations.

I do not accept the Deputy's view that our GPs do not honour their contracts. I believe they work extraordinarily hard in difficult circumstances. GPs need a new contract too. I have already outlined for the Deputy what the HSE will do in the interim for patients. We need to hammer out this issue as part of the contract negotiations.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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It is patiently obvious that GPs are flouting the current agreement and charging for this service. The fact that there is an arrangement in place to address situations where this arises indicates that GPs are clearly flouting the current agreement. It is entirely in order, therefore, that I would question the wisdom of cutting another deal with the same people who as the Minister said are flouting the current agreement and are doing things that they are not supposed to be doing. Perhaps it would be possible to send a message from the Department of Health to GPs instructing them to take down the signs I mentioned earlier because they are causing a great deal of concern. I am concerned that there might be people visiting GP surgeries who are unable to pay for a blood test or to go to a hospital to have it done who may decide to go home rather than present to the doctor for a test that they cannot afford to pay for. The signs need to be taken down. They are not a welcome addition in GP surgeries.

Simon Harris (Wicklow, Fine Gael)
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It is of concern to me that people are being referred to hospital for a service that can be adequately provided in primary care and which the GMS contract enables to be provided in primary care. However, I do not want to escalate this disagreement with our GPs in the context of contract negotiations which have already commenced. My Department and the HSE have commenced the process of engaging with GP organisations. I will ask the HSE to reflect on the Deputy's views on the signs and to report back to me on the matter. As I outlined earlier, there is recourse available for patients. I am determined to ensure we have a modern fit-for-purpose contract that GPs and patients can benefit from in the interests of a decisive shift to primary care. That is my priority.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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Will the Minister keep me updated on this matter?

Simon Harris (Wicklow, Fine Gael)
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I will communicate in writing with the Deputy on the matter.