Fidelma Healy Eames (Fine Gael)

I am pleased the Minister of State is present to listen and respond to this Adjournment matter. This is my first time speaking with her in her ministerial capacity. I congratulate and wish her the best of luck.

My request is for the HSE to enable registered nurse prescribers, RNPs, from the private and voluntary nursing home sector to prescribe general medical services, GMS, products for medical cardholders who are nursing home residents. Nurse prescribing was introduced by the then Minister for Health and Children, Ms Mary Harney, and was initially only open to the public sector. The criteria have been changed to allow all nurses to apply, including those from the private and voluntary sectors. Strict criteria, mainly concerning governance and supervision, were put in place.

It has become apparent that there is an issue with RNPs who have completed the course and are registered with An Bord Altranais prescribing for patients with medical cards. This makes no sense, as there is no issue with prescribing to private patients under the same roof. RNPs can prescribe to these patients once they fulfil the terms of an approved collaborative practice agreement but they cannot prescribe using GMS pads in private practice. What is the rationale?

RNPs working in elderly care services in the private sector cannot prescribe for 95% of residents. The number of long-term places for older people in the public sector are limited. Since the introduction of the fair deal, older people can choose where they are placed. Technically, this means that people in private nursing homes are at a disadvantage, as they cannot be treated by RNPs even if their GPs have agreed to that treatment. Circular SO222-NCO-09, of May 2009, alignment of community drug schemes to incorporate nurse and midwife prescriptions, did not reference restrictions to RNPs in the private and voluntary sectors, although it alluded to further circulars to be issued to clarify the policy decision on the GMS scheme. This circular reiterates that the legislation allows registered nurses and midwives who have completed an approved education programme, appropriate clinical experience, registered with An Bord Altranais as RNPs and authority from the health service provider employing them to prescribe a range of medications within their scope of practice. Nowhere within this clarification of the legislation does it refer to restrictions on RNPs in the private or voluntary sector. If so, why can they not prescribe in practice?

In July 2011, circular 01/311, community registered nurse prescriber primary care prescription pads, outlined specific criteria to apply to community RNPs in the HSE's voluntary and statutory services. RNPs from the private and voluntary nursing home sectors fulfil four of the six, yet the circular states that RNPs in private nursing homes will not be issued with primary care prescription pads. It does not provide a rationale for this decision.

The majority of residents in private and voluntary nursing homes hold medical cards and receive medical services from GPs who are under contract with the HSE. Furthermore, a number of these residents are in beds that have been contracted by the HSE under the contract bed or delayed discharge initiative. When responding to a parliamentary question from Deputy Stanley on 12 April 2011, the Minister for Health, Deputy Reilly, stated:

It is important to note that a person's eligibility for the medical card and drugs payment schemes is unaffected by the nursing homes support scheme. In other words, a person can continue to receive goods and services in accordance with the terms of these other schemes regardless of whether they are in a nursing home or elsewhere.

Given the stress under which the HSE is operating, this issue needs a common sense approach. RNPs offer a vital and cost effective service to older people. Without them, doctors need to be called for emergencies and transfers need to be arranged to accident and emergency departments. The RNP could examine, diagnose and treat people in the interim. The current situation does not make much financial sense.

The HSE should enable RNPs in the private and voluntary nursing home sector to prescribe GMS products for residents who hold medical cards. While the preference would be for RNPs to have primary care prescription pads with their own GMS numbers, it would be acceptable, albeit more difficult in the interim, were the Primary Care Reimbursement Service to issue a circular to GPs concerning GMS prescription pads for RNPs who provide services for the former's patients in private and voluntary nursing homes, as per the practice outlined for practice nurses in the circular to which I referred. I look forward to the Minister of State's reply.