Adjournment Debate. - Flu Vaccine.

It is generally recognised by the medical profession that influenza can have a serious and sometimes fatal effect on vulnerable groups, particularly the elderly. A decision was made a number of years ago to issue a free 'flu vaccine to general practitioners which could be administered to GMS patients. There was some controversy earlier this year about whether the scheme would continue after the doctors' organisation said they would have difficulty continuing it unless it was put on a particular footing.

I received an inquiry some time ago from an elderly gentleman about this matter. He and his wife are in bad health; she is regularly admitted to hospital. He contacted me to tell me that when he went to get the flu vaccine, he was informed by his GP that it would not be administered unless he paid £15. This was in spite of the fact that the man and his wife are elderly and have medical cards.

I subsequently wrote to the Minister for Health and Children, asking him for the up to date position regarding the scheme, and I was informed by letter some time later that agreement had been reached between the Irish Medical Organisation and the Department of Health and Children and the 'flu vaccine would be administered to all GMS patients free of charge. I was delighted to receive the reply and I forwarded it to my constituent. He then made another trip to his GP only to be told that he would not be given the flu vaccine unless he paid £15. The elderly gentleman telephoned me and said he had received my reply, but it was incorrect. His GP told him it was not free and that he would be charged £15.

In an effort to clarify the matter, I telephoned the GP concerned. In fairness to him, he was not trying to rip off patients or claim an additional fee for services. The opposite was the case. In a conversation with me, he told me that as a matter of principle he would not administer the scheme. I have a copy of a letter the GP, Dr. Leonard Condren who practises in Ballyfermot, Dublin 10, submitted toForum, which I understand is the magazine for general practitioners. It states:

I am very disappointed at the current debacle regarding influenza vaccination. As a matter of principle I am returning my free supply of vaccines to the Eastern Health Board and will purchase replacement stock from an appropriate supplier.

I intend to administer the vaccine to all my at risk patients who present for it. A discounted inclusive fee will be equally applied to GMS and private patients. Those GMS patients unable to afford the fee will be advised to immediately attend the surgery for a prescription of Relenza should they develop symptoms of influenza.

This policy will ensure that inability to pay will not block my patients from receiving the care they are entitled to. It also ensures that I am not compromised by using vaccine stocks from a health board which is not committed to prevention.

From my conversation with Dr. Condren, I understand he is one of only a few doctors in my constituency who are not participating in the scheme. If there are others, I am not aware of them. I am concerned that action by an individual doctor or a number of GPs would leave patients, and particularly elderly people, at risk during the winter of contracting influenza with all its associated risks and problems.

The GP concerned told me that, as far as he is concerned, a proper structure has not been put in place to administer the scheme and there is anad hoc arrangement whereby GPs will give the flu vaccination to patients for an out of hours fee. He believes the scheme is not being administered correctly and he will not participate in it. In the meantime my constituents are at risk and I want the Minister to tell me if the Department and GPs in the GMS have agreed a scheme. In the meantime my constituents are at risk. I want the Minister to let me know if there is an agreed scheme between the Department and the general practitioners in the GMS.

I thank Deputy McGennis for raising this issue.

I would like first to set out the general background to this issue. Each year the health boards purchase a quantity of influenza vaccine for provision to at-risk persons in the GMS population. In 1998 the quantity purchased was increased by 50% to approximately 300,000 doses, and a similar quantity has been purchased this year. The at-risk group includes all persons over 65.

This vaccine has for many years been given to GMS patients by their general practitioners as part of the service covered by the capitation payment they receive for medical card patients. However, this year the Irish Medical Organisation sought a specific payment for providing the vaccine to GMS patients. The health boards' position is that they are not agreeable to a charge for a service which was previously provided without charge.

Discussions on the issue have been held at the Health Service Employers' Agency. At a meeting on 7 October the Health Service Employers' Agency, recognising that there are issues between the parties regarding administration of the influenza vaccine, and in order to resolve this dispute without delay, proposed that the issues be referred to an independent third party for adjudication. This would have included consideration of the question of whether GPs should receive a separate payment for giving the flu vaccine. However, this offer was declined by the Irish Medical Organisation. Subsequently, the IMO advised its members to ensure that all at-risk medical card holders were vaccinated free of charge and the Minister and I welcome the fact that, notwithstanding the dispute regarding its administration, medical card holders have therefore been able to receive the influenza vaccine as in previous years.

In relation to the particular case cited by the Deputy, the Department has been informed by the Eastern Health Board that a general practitioner returned to the board the stocks of influenza vaccine supplied to him. The board understood that the doctor in question proposed to obtain future supplies of the vaccine from the pharmacist.

The Minister remains hopeful that it will be possible to reach agreement on this issue and that the Irish Medical Organisation will reconsider the offer made by the health service employers of referral of the issue in dispute to an independent third party.

As the Deputy has said, there are a number of issues here. Most general practitioners have given the vaccine and are awaiting an outcome on the arbitration. Unfortunately that has not taken place yet. Other doctors gave the vaccine on the basis of after hours service or fee per item of service. That is how things stand at the moment.