Under the terms of the current GMS contract, GPs are required to provide eligible patients with, ''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". There is no provision under the GMS GP contract for persons who hold a medical card or GP visit card to be charged for routine phlebotomy services provided by their GP, or the Practice Nurse on behalf of the GP, which are required to either assist in the diagnosis of illness or the treatment of a condition. The HSE has advised GPs that where a blood test forms part of the investigation or necessary treatment of a patient’s symptoms or conditions, this should be free of charge for patients who hold a medical card or GP visit card. Notwithstanding this, I am aware that in recent times some GPs have begun to charge GMS patients for phlebotomy services in some circumstances.
This is a matter of concern for me as it has long been the position of the Government and the Oireachtas that no user charges should apply to GP services provided to GMS and GP visit card patients. If a patient who holds a medical card or GP visit card believes he or she has been incorrectly charged for routine phlebotomy services by his or her GP, then that patient may make a complaint to the HSE Local Health Office, who will deal with the matter in accordance with the HSE's Complaints Policy. In order to achieve clarity on this issue, I have asked that any difference of perspective in relation to the provision of phlebotomy services be addressed in the GP contractual review process, which is currently under way. The aim is to develop a contract which has a population health focus, providing in particular for health promotion and disease prevention and for the structured ongoing care of chronic conditions. I look forward to constructive and positive engagements with a view to achieving a satisfactory outcome.
The GMS contract stipulates that 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 GPs outside the terms of the GMS or GP Visit Card contracts are a matter of private contract between the clinicians and their patients.