Brendan Smith (Cavan-Monaghan, Fianna Fail)
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To ask the Minister for Health the payments currently paid to general practitioners in respect of medical card patients; the details of the individual charges for each category of card holder, that is, child, adult, family, over 70 years, GP visit only card or whatever way the charges are structured; the additional payments made; the make-up of same, be that pensions, surgery, maintenance or upgrading, staff and so on; if he will list the normal GP services which are not covered by medical card, that is, driving test forms, blood tests and so on; and if he will make a statement on the matter. [17773/13]

Alex White (Dublin South, Labour)
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The HSE, through the Primary Care Reimbursement Service (PCRS), makes payments to contracted General Practitioners (GPs) for services they provide to eligible persons who hold a medical card or GP visit card in accordance with the rates set out in the Health Professionals (Reduction of Payments to General Practitioners) Regulations 2010 - SI 638/2010, which are available online at http://www.irishstatutebook.ie/2010/en/si/0638.html

There is a range of capitation fees, which vary depending on the age and gender of the patient. In addition, there are special capitation rates for persons over 70 residing at home and for persons over 70 residing in private nursing homes. There are also a number of additional payments, e.g. in respect of out-of-hours consultations, temporary residents, special items of services (including suturing of cuts and lacerations, recognised vein treatment, etc.), practice support allowances and payments in respect of locum expenses.

In addition, medical indemnity insurance premia are refunded to contracted GPs based on the size of each GP's GMS panel. The HSE also pays into a superannuation scheme a sum equivalent to 10% of total capitation fees payable to contracted GPs.

The PCRS publishes a Statistical Analysis of Claims and Payments for each year in respect of payments which it makes to contracted health professionals, including GPs. These are available on line at: http://www.pcrs.ie/ PCRS Publications.

Clause 11 of the current GMS Contract states as follows:

“The medical practitioner shall provide for eligible persons, on behalf of the relevant Health Board, all proper and necessary treatment of a kind usually undertaken by a general practitioner and not requiring special skill or experience of a degree or kind which general practitioners cannot reasonably be expected to possess. This will include such preventive and developmental services as are currently provided or may be developed in the new style of practice which this agreement facilitates, some of which services may be included on the list of special items of service for which specific payments shall be made. ”

It is the contracted responsibility of GPs to provide proper and necessary treatment to eligible persons. If part of that proper and necessary treatment includes routine phlebotomy, GPs must provide such services free of charge under the terms of their contract.

The monitoring and appropriate care of patients receiving anti-coagulation therapy with Warfarin comes within the scope of competence of general practice. Warfarin testing is carried out by some general practitioners as a matter of course in their practices and I welcome this. This provides their patients with an option of receiving this service locally in a primary care setting rather than attending an acute hospital for this service.

Under the GMS contract, fees are not paid to GPs by the HSE in respect of certain medical 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.

Consultation fees charged by general practitioners to patients outside the terms of the GMS contract are a matter of private contract between the clinicians and the patients. While the Minister for Health has no role in relation to such fees, it would be expected that clinicians would have regard to the overall economic situation in setting their fees.

The Programme for Government provides for the introduction of a new GMS GP contract with an increased emphasis on the management of chronic conditions, such as diabetes and cardiovascular conditions. It is envisaged that the new contract, when finalised, will focus on prevention and will include a requirement for GPs to provide care as part of integrated multidisciplinary Primary Care Teams. The arrangements in relation to the various services provided to GMS patients, including phlebotomy services and anti-coagulation therapy will be reviewed as part of this process.