Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I welcome the new arrangements announced recently by the Minister of State, Deputy Feighan, for those with medical prognoses of up to 24 months to be eligible for a medical card. I would go further in this regard and state that all cancer patients, regardless of their prognoses, should be automatically approved for a medical card. Cancer patients can be given a discretionary medical card, but there are no common rules for applying that discretion and there are delays in the application system. I ask the Minister of State to examine this situation.

The existing medical card system has many issues. While this temporary arrangement fixes one issue, there are others and I am here to discuss one of those issues today. The provision of routine blood tests without charge to holders of medical cards or general practitioner, GP, visit cards is included under the current general medical services, GMS, contract. However, some GPs continue to charge GMS patients for blood tests in some circumstances. There is no provision under the contract for medical card or GP visit card holders to be charged for blood tests provided by their GP to either assist in the diagnosis of illness or the treatment of a condition. These blood tests should be free of charge for patients who hold a medical card or GP visit card.

In the midst of a pandemic, my office is still inundated with calls about GPs charging some people who have medical cards for blood tests. I am concerned that the only way to have these charges refunded is to write a letter to the HSE seeking it. The patient in that case must compose a letter outlining why he or she went to the doctor to have their blood test and they then have to send the letter to the HSE.

I recently submitted a parliamentary question on the numbers seeking such refunds in my constituency. I was informed by the HSE that seven refund applications were made last year and seven refunds were issued. My office is inundated with calls on this matter, so I am certain that the procedure to apply for the refund is a barrier to applicants. More people come to me than these figures would suggest and we do our best to help them. The act of having to lay out all the information in a letter is difficult, however, and I do not think we should be allowing this to happen.

If legislation is needed, I am happy to work with the Minister of State on it. If GPs need to be guided in a better way, I am also happy to assist the Minister of State with that endeavour. At the very least, however, we must stop this charging for blood tests for medical card patients when they are not supposed to be charged. I am happy to help and to seek the refunds on behalf of my constituents, but it is wrong that this must be done. It is wrong to put patients through this process and I ask the Minister of State to examine a better option. These tests should be free and we must get some legislation in this area.

While I am talking about the subject of medical cards, another issue on which I am receiving many calls concerns dentists not taking medical cards. I have been contacted by several people with medical cards and they have told me that dentists will not take their medical cards. That is unacceptable. We must ensure that cannot happen and I ask the Minister of State to ensure that we get this situation sorted out as soon as possible.

It has been a year and the issue persists.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Deputy for raising this important issue. Persons who are eligible for GP care without charge under the Health Act 1970 are not subject to co-payments or other charges in respect of such services. There is no provision under the general medical services, GMS, GP contract for persons who hold a medical card or GP visit card to be charged for routine phlebotomy services provided by their GP that are required to assist either in the diagnosis of illness or in the treatment of a condition. The HSE has advised GPs that where a blood test forms part of an 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. Routine blood tests that are deemed clinically necessary by the patient's GP are comprehended by the scope of this service.

Notwithstanding this, the Minister, Deputy Donnelly, is aware that some GPs are charging GMS patients for phlebotomy services in some instances. The issue of charging GMS patients for phlebotomy services is complex, given the numerous reasons and circumstances under which blood tests are taken. The matter is further complicated by the fact that it is difficult to make precise distinctions between routine and non-routine phlebotomy services.

It is a matter for the treating GP to determine in the case of each individual patient what is proper and necessary care. In circumstances where a GP determines that a particular treatment or service requested by a patient is not clinically necessary but the patient still wishes to receive same, it is at the GP's discretion as to whether a charge is imposed for providing the service. The GP chronic disease management programme will involve the ongoing monitoring of patients' condition, and any blood test required in this context will be covered by the fees payable for this care. Where a patient who holds a medical card or GP visit card believes he or she has been incorrectly charged for routine phlebotomy services that he or she should have received without charge, he or she should report this to the HSE local primary care management, which will investigate the matter.

The role of local primary care management within each community healthcare organisation, CHO, is to investigate in the first instance the validity of any claim a GMS patient makes regarding charges inappropriately levied by his or her GP of choice for blood tests undertaken at the GP's practice as part of the investigation and necessary treatment of the patient's symptoms or condition. If it is established an inappropriate charge was levied on the patient for routine phlebotomy services, the HSE primary care eligibility and reimbursement service, PCERS, is notified accordingly. PCERS will, based on the recommendation of the local health manager, make a full refund to the patient concerned. Given the complexity of the issue, it is not possible to further streamline the process of seeking refund for blood test charges.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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That is not acceptable. If a patient has a medical card or GP visit card, he or she should be entitled to a free blood test. I compliment doctors. I know how hard they have worked, particularly in the past year with Covid. It has been very difficult for everyone. Even so, vulnerable, often elderly, people who have medical cards have approached me on the matter. When someone has a medical card or a GP visit card, he or she should automatically be entitled to a free blood test. I do not accept the Minister of State's response. It is not the right answer and I ask him to reconsider it. We need to address the issue. I have had several phone calls about it. It is very unfair for people who have to write to the HSE and explain why they had a blood test. It is not acceptable. I urge the Minister of State to seek that all medical card and GP visit card holders will be allowed to get a free blood test.

I wish to raise also the issue of medical cards in respect of dental treatment. Covid has been so hard on everyone. This year has been very difficult. I know how hard our front-line workers and doctors have worked, but I had phone calls this week but from two people who have medical cards. They were both told by dental clinics that they would not accept medical cards. Again, this is unacceptable and we need to examine it. What can we do to sort this out? What can I do to work out the issue for those people who came to me? We need to do something. I do not know how many dentists are refusing medical cards but I have received phone calls to say that some are. The same is true of some doctors. I ask the Minister of State to reconsider this and to revert to me with some sort of answer and solution. We cannot have this going on. It is unacceptable.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I again thank the Deputy for raising this important issue. I will bring her concerns to the Minister because she has articulated them in a passionate and informative way, and I hope this will be dealt with. The position of the Department and of the HSE has consistently been that routine blood tests are comprehended by the provisions of the GMS and that there should be no charges for routine blood tests. As I mentioned, however, the issue of GPs charging GMS patients for phlebotomy services is complex and the Department and the HSE have discussed this issue with GP representatives. Unfortunately, it did not prove possible to reach agreement that no charges for blood tests would be applied in any circumstances, but it is intended to raise the issue again at an appropriate time. The HSE has put in place a process whereby the local health office will investigate on a case-by-case basis complaints from GMS patients who believe they have been inappropriately charged and will, where appropriate, arrange for a refund to the patient.

I have listened to the Deputy and will bring the issue to the Minister to try to get it resolved as quickly as possible. It is not satisfactory but issues need to be resolved between all the stakeholders. I hope they will be resolved as quickly as possible.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I am charged through Standing Orders with adjudicating on complaints from Deputies about responses to parliamentary questions or to Topical Issue matters, and I get many complaints. I would certainly welcome a complaint about this response because, while I do not in any way blame the Minister of State, who always comes to the House to do his very best, it seemed to be nothing more than an unadulterated fudge.