John Gormley (Dublin South East, Green Party)
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Question 137: To ask the Tánaiste and Minister for Health and Children her views on the medical card scheme providing payment to general practitioners who employ a full or part-time physiotherapist in their practice, thus reducing demands on hospitals; and if she will make a statement on the matter. [25194/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Primary Care — A New Direction (2001) set out this Government's vision for the development of primary care as a central focus in the delivery of health and personal social care services. The Strategy aims to shift the emphasis from an over-reliance on acute hospital services to one where patients can access an integrated multi — disciplinary service in their local community. I am confident that this development of the services available in the primary care setting can reduce the demand on acute services in hospitals by meeting the vast majority of day-to-day health care needs in the local community.

There is currently no provision within the GMS contract for general practitioners to receive additional remuneration in respect of the delivery of a physiotherapy service in the manner suggested by the Deputy.

Implementation of the Primary Care Strategy is focusing on the development of integrated multi-disciplinary teams including general practitioners, nurses, health care assistants, home helps, occupational therapists, physiotherapists and others. The 2006 Estimate for the HSE includes an additional €10 million in revenue funding to enable the establishment of up to 100 new primary care teams. This will enable the provision of some 300 additional frontline personnel to work alongside GPs in order to provide integrated and accessible services in the community. The draft national partnership agreement, if ratified by the social partners will provide for the development of further primary care teams during the lifetime of the agreement.

Billy Timmins (Wicklow, Fine Gael)
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Question 138: To ask the Tánaiste and Minister for Health and Children the situation regarding a general practitioner who wishes to set up a private practice in an area with respect to accessing medical card patients; if there are restrictions on the GP; if there is a limit to the number of medical card patients permitted per doctor; and if she will make a statement on the matter. [25228/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Entry to the General Medical Services (GMS) Scheme for general practitioners is normally through open competition and interview following advertisements in national and medical newspapers. All suitably qualified persons may apply for these positions. The Health Act 2004 provided for the Health Service Executive (HSE), which was established on 1 January 2005. Under the Act, the Executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for the selection and recruitment of general practitioners to provide services under the GMS Scheme.

Applicants for GMS GP contracts, whether from this or another jurisdiction, must satisfy the provisions of EU Directive (93/16/EEC). This Directive facilitates the free movement of doctors and the mutual recognition of their diplomas, certificates and other evidence of formal qualifications. It also stipulates the requirement in respect of vocational training for persons seeking to be considered for such posts.

As part of agreements between the Department of Health and Children and the GP representative body, the Irish Medical Organisation (IMO), made in 1999 and again in 2001 between the Health Service Employers Agency and the IMO, limited entry to the GMS Scheme was possible for suitably qualified GPs. These agreements allowed for those GPs who were interested and qualified to hold limited GMS contracts. These limited GMS contracts allowed GPs to treat their over 70s patients who qualified for a medical card for the first time, following the phased increase in the income level for eligibility assessment in 1999, and again following the introduction of the statutory entitlement to a medical card for all persons aged 70 years and over from 1 July 2001. After specified periods GPs holding these limited contracts would become eligible for full GMS contracts and be able to provide services to any medical card patient who might choose to be included on their patient panel list.

Also in June 2005 the Labour Relations Commission (LRC) recommended a once off entry arrangement be provided for doctors accepting GP Visit card patients and who met certain qualifying conditions.

Under the GMS Scheme general practitioners hold one of two contract types i.e. the Fee per Item contract (first introduced in 1972) or the Capitation contract (effective from 1989). These contracts reflect the agreed outcome of negotiations between the Department of Health and Children and the IMO. Both contract types contain provisions which were agreed between the parties on a range of issues including the limitation of numbers of patients placed on the list of the practitioner.

Under the 1972 and 1989 contracts the number of persons whose names may be placed on the list of the practitioner shall not exceed 2,000 save where the HSE, in exceptional circumstances, after consultation with the IMO, decide to apply a higher limit.

A review of the contractual arrangements for the provision of services under the GMS and other publicly funded schemes commenced in October 2005 and is being conducted under the auspices of the LRC. As part of the contract framework the management team are seeking to agree open access to GMS contracts for all qualified GPs.

Róisín Shortall (Dublin North West, Labour)
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Question 139: To ask the Tánaiste and Minister for Health and Children the reason old age pensioners with medical cards have to pay for a medical certificate in order to renew their driving licence; and if she will make a statement on the matter. [25277/06]

Billy Timmins (Wicklow, Fine Gael)
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Question 142: To ask the Tánaiste and Minister for Health and Children the position in relation to the doctors charge for the over 70s who need an eye sight test fo their driving licence renewal applications; if she will have same examined with a view to having this test covered under the medical card; and if she will make a statement on the matter. [25286/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 139 and 142 together.

In making arrangements for the provision of publicly funded GP services, under the General Medical Services (GMS) Scheme, an agreement was negotiated between the Department of Health and Children and the GP representative body, the Irish Medical Organisation (IMO). The provisions of this agreement took the form of the current GMS GP Capitation Contract. This contract is a treatment based contract and gives effect to the statutory requirement to provide free GP medical and surgical services to eligible people which includes people aged 70 and over who are automatically entitled to a medical card. The contract stipulates that the fees paid to the GMS GP's are not made in respect of certain certificates which may be required for example 'under the Social Welfare Acts or for the purposes of insurance or assurance policies or for the issue of driving licences'. As these non-treatment type services are outside of the GMS contract it is a matter between the GP and the person seeking the particular services to agree a fee.

While certificates for applications are provided by medical practitioners they are not a medical service and are not considered a core aspect of public health service provision. Requiring such services to be provided within the terms of the GMS GP contract would more than likely lead to a costly counterclaim by GP's which if allowed would not represent appropriate or best use of resources in terms of current health policy.