John O'Mahony (Mayo, Fine Gael)
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1465. To ask the Minister for Health if there is a charge payable from the holder of a medical card direct to a general practitioner for medical card holders who receive a 'flu jab; and if he will make a statement on the matter. [37999/13]

John O'Mahony (Mayo, Fine Gael)
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1466. To ask the Minister for Health if a medical card holder has to pay a general practitioner for having blood taken to diagnose a condition or to monitor an ongoing condition; and if he will make a statement on the matter. [38000/13]

Alex White (Dublin South, Labour)
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I propose to take Questions Nos. 1465 and 1466 together.

The Health Professionals (Reduction of Payments to General Practitioners) (National Immunisation Programmes) Regulations 2013 - S.I. No. 278 of 2013 specify that the amount payable to a general practitioner for administering to an individual in an "at-risk" category an influenza vaccine under the General Medical Services Scheme provided that the influenza vaccine is not administered by the general practitioner (or by another general practitioner in the same practice) on the same day as a PPV is €15.

The vaccine and its administration are free of charge to persons in the “at-risk” category who have a Medical Card or GP Visit Card. In such cases, the €15 fee is reimbursed to the GP by the Primary Care Reimbursement Service.

The following are deemed to be in the "at risk" category and are recommended for Influenza Vaccination:

- persons aged 65 and over;

- those with a long term medical condition such as diabetes, heart or lung disease;

- people whose immune system is impaired due to disease or treatment;

- residents of nursing homes or other long-stay institutions;

- persons with a body mass index (BMI) over 40;

- pregnant women (vaccine can be given at any stage of pregnancy);

- healthcare workers;

- carers;

- people in regular close contact with poultry, water fowl or pigs.

Where a Medical Card or GP Visit Card holder is not in the “at-risk” category, the vaccine and its administration are a matter of private contract between the patient and their GP.

Under the GMS contract, a GP is expected to provide his/her patients who hold a Medical Card or GP Visit Card with all proper and necessary treatment of a kind generally undertaken by a GP. Where blood tests form part of the investigation and necessary treatment of patients' symptoms or conditions, these should be provided free of charge to Medical Card and GP Visit Card holders. The HSE also points out that, in many GP surgeries, it is the practice nurse who takes blood samples. The HSE significantly subsidises the cost of employing practice nurses.

The HSE is continuing to advise eligible patients who believe they have been inappropriately charged by a GP for routine phlebotomy services, to seek a refund from the GPs in question. It is appreciated that because of the nature of the GP/patient relationship, it may be difficult for patients to make such complaints. Where public representatives are made aware of GPs charging GMS patients in error, they may wish to notify the HSE directly.

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.

Officials in my Department are in consultation with the HSE with a view to drawing up a new contract. The appropriate arrangements in relation to phlebotomy services will be considered as part of the new contract.