Under paragraph 11 of the General Medical Services (GMS) contract, a general practitioner (GP) shall provide for eligible persons, on behalf of the HSE, all proper and necessary treatment of a kind usually undertaken by a GP and not requiring special skill or experience of a degree or kind which GPs cannot reasonably be expected to possess. Under paragraph 27 of the GMS contract a GP shall not demand or accept any payment or consideration whatsoever from a GMS patient in reward for services provided by him/her under this contract, or for travelling or for other expenses incurred by him/her or for the use of any premises; equipment or instruments in making the services available.
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 also available free of charge in hospitals. Warfarin testing is carried out by some GPs 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 the service. In relation to other blood tests, in circumstances where the taking of blood is necessary to either (a) assist in the process of diagnosing a patient or (b) monitor a diagnosed condition, the GP may not charge that patient if they are eligible for free GMS services under the Health Act, 1970, as amended.
The HSE has written to GP contract holders and clarified the position in relation to this matter and has also communicated its position to the Irish Medical Organisation. Any alleged instances of eligible patients being requested to pay for a routine service of this nature from their own limited resources is viewed as a serious matter by the HSE and the Department. I have been advised by the HSE that its Local Health Offices will fully investigate any reported incidents of eligible patients being charged for phlebotomy services which form part of the investigation and necessary treatment of patients' symptoms or conditions. In such cases, where a medical card holder or a GP visit card holder has been inappropriately charged for the taking of blood, the HSE will make deductions from those GPs' routine GMS payments.
Officials in my Department are in consultation with the HSE with a view to drawing up a new GMS contract. The appropriate arrangements in relation to anti-coagulation therapy and phlebotomy services will be considered as part of the new contract.