John Kelly (Labour)

I welcome the Minister to House. This welcome legislation is simple and self-explanatory, giving greater choice to people and leading to greater competition in the general practice market. Hopefully, it will limit the emigration of our trained GPs and even facilitate the return of those who had to emigrate in the past. As Senator MacSharry noted, other measures could also be considered, whether in the context of this Bill or through other legislation, to deal with the pricing system operated by some GPs. Prices should be built into GPs' contracts with the HSE. As they are already well paid for medical card patients, they should not be allowed to charge a further €50 to write a letter so that a patient can apply for a medical card. This practice should be outlawed under the legislation.

It is scandalous that somebody in receipt of disability benefit who requires a doctor's certificate on a weekly basis might have to pay €30 for it. People should not have to pay for this service if they are patients of the doctor concerned. Similarly, medical card patients should not have to pay extra to have their bloods taken. The practice that the Minister described as having the shoe box on the table should also be outlawed. Elderly people should not feel obliged to give their doctors additional money to get better care. If they want to give the money to the Department of Health, we could put it to better use than giving it to well-paid GPs.

I acknowledge that the Minister is not to blame for the management of medical card system by the primary care reimbursement service, PCRS. More than 12 months ago I warned that the change to the medical card system would be a disaster. The issue has been raised with the Minister on previous occasions but, unfortunately, he has accepted the assurance from the PCRS that 85% of medical cards are being dealt with the normal way. I know for a fact this is not true, however, and I could set out any amount of examples to support my contention. I invite the Minister to come to my office and listen on speaker phone when I eventually get through to the PCRS to ask about five different cases. The bottom line is that it appears to be losing applications. If a medical card application is straightforward there is no problem but even one complication creates problems because the PCRS will write back to the applicant after two weeks to request further information or admit to losing something. In one case, an application was submitted on 25 September and the PCRS wrote to the family concerned to say it lost the husband's payslip. I have been in regular contact with the PCRS over the past three weeks because it cannot find any information pertaining to the file but it asked us to resubmit the entire application. This example is repeated on a daily basis. I do not know what it is telling the Minister but it has a huge problem on its hands.

Since it took over the control of medical cards, its approach has differed to that of the HSE. For example, an applicant aged between 16 and 25 years who lives at home is only issued with a medical card if his or her parents also have one. That was never the case previously. The guidelines for medical cards set out an income threshold of €164 for those who live with their families. I have it on the highest authority that PCRS is wrong in its interpretation but it is not for changing. To offer another example, people who have a right to medical cards by virtue of being on community employment or rural social schemes are being told their families have to be means tested.

The guidelines for medical cards were last updated in 2005 or 2006. I suggest that they need to brought in line with social welfare rates. Anybody on the baseline of social welfare is barely above the poverty line and the medical card guidelines set out incomes that are far below the poverty line.

The Minister referred to the long-term illness scheme but I missed what he said. He has included other long-term illnesses in the scheme. Are cancer patients among the categories of people who will be considered for a long-term illness book?

Senator MacSharry referred to the out-of-hours doctor service. This service is not working. Doctors used to work on the basis of a rota system so that a local GP was always on-call at weekends. Given that we are about to open up to competition and increase the number of GPs in the market, perhaps it is time to reconsider a rota system because the new GPs might be delighted to work weekends and be on the golf course on a Wednesday afternoon.

In regard to protection for GPs based on the potential viability of their practices, newspaper reports of earnings of €600,000 and €800,000 from the GMS scheme suggest there is room for more GPs. It is said that one never sees a bookie going out of business. I never saw a GP going out of business.