A while ago I became aware that people were having difficulties finding a GP surgery to take them under the recently launched GP Visit Card scheme. I was also aware that some surgeries considered their medical card lists closed and were no longer accepting any new public patients.
The GP Visit Card is sometimes termed a ‘Medical Card Lite’ and is a middle ground offering for people who do not qualify for a full medical card yet can be covered for the cost of primary care under the system. The income limits are much more generous than under the full medical card scheme and take into account expenses such as mortgage, childcare and commuting costs.
It struck me there are two aspects to this issue. The first is the situation where someone is living in a rural or other location where there is only one GP facility within reach. If that person, on either Medical or GP Visit Card, is turned away from that facility they have limited other options especially if they do not have own means of transport.
The other situation which appears relatively common, is where people have been paying patients with their GP until such time as they applied for these new GP Visit Cards, whereupon they are refused service from the same GP that has done and will continue to see them privately.
There is undoubtedly an issue of capacity as the population has grown so rapidly – but there is also an issue of fairness and equal access to services, particularly in the cases where the same person finds they can be seen on a cash basis but not on their card.
So I made some enquiries and put a question to the Minister for Health, via Deputy Áine Brady. I include responses received below. It appears the system is under review and subject to ongoing negotiations with the IMO and so forth. However in the short term there is a ‘get-out’ clause for anyone caught in this predicament. In a nut-shell, three refusals is the limit and the HSE will intervene. If someone has been refused from their initial GP what they need to do is contact two other surgeries, request services from them, and if they are turned away again, send details of the three refusals – that is the names and addresses of three surgeries that could not accommodate them – and send those details into their local HSE centre which in our case is HSE ; Kildare / West Wicklow Local Health Office, Poplar House, Poplar Square, Naas, Co Kildare (or Tel 045 876 001).
The preferred or local GP should be indicated amongst the three, and the HSE will then intervene to ensure the person is accomodated – and usually in the facility of first choice. It’s not ideal but at least it’s a work-around for now. And we’ll watch this space for the Minister’s review.
Full Responses Below:
Reply to Deputy Brady
Under the Health Act, 2004, the Health Service Executive (HSE) has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for arrangements to ensure appropriate service delivery for General Medical Services (GMS) Scheme (medical card and GP visit card) patients.
Services under the GMS Scheme are provided by general practitioners (GPs) holding contracts with the HSE. The terms of these contracts were agreed on foot of negotiations with the Irish Medical Organisation (IMO). Under the terms agreed, contracts are made available where the HSE decides, after consultation with the IMO, that there is a need for a service having regard to a range of factors, including whether the needs of the population in the area are met by the services already available. The agreement also provides that the number of persons on a GP’s patient panel may not exceed 2,000, save in exceptional circumstances. Not all GPs hold GMS contracts, as they may not qualify or wish to provide services under the Scheme.
When a person qualifies for a medical card or GP visit card, he/she accesses services by choosing a GP from a list of local GPs who have been contracted to provide services under the GMS Scheme. The person will be assigned to the GP he/she has chosen from the list subject to the GP’s acceptance and his/her total patient list being within the agreed limit. If a person is unsuccessful in locating a GP who is able to take on additional patients, the HSE may in certain circumstances assign an eligible patient to a medical practitioner’s list.
The arrangements for the provision of publicly funded GP services, including those provided under the GMS Scheme, are under review. I regard the existing arrangements in relation to access by GPs to public contracts as unnecessarily restrictive and it is my wish that new contractual arrangements for the provision of publicly-funded GP services should ensure that HSE contracts are open to all suitably qualified and equipped doctors.
As aspects of the Deputy’s question relate to the management and delivery of health and personal social services, which are the responsibility of the Health Service Executive, my Department has requested the Parliamentary Affairs Division of the Executive to arrange to have this matter addressed and to have a reply issued directly to the Deputy.
Office of Assistant National Director PCCC- Contracts,
National Contracts Office,
Health Service Executive,
Marlinstown Office Park,
Phone: 044 9330762
Fax: 044 9330763
Ref: PQ ref no: 11427.08
Deputy Aine Brady,
Re: Parliamentary Question 11427.08
PQ: To ask the Minister for Health and Children the guidelines in place for medical centres and general practitioners which allow or facilitate medical cards to be used with them (details supplied); and if she will make a statement on the matter.
Dear Deputy Brady,
I refer to the above Parliamentary Question and set out the reply hereunder.
Under the Card Scheme patients are given a choice from a list of General Practitioners who hold contracts for the provision of services under Section 58 or the Health Act 1970. This list is available from the local Medical Card office. On checking with the local Primary Care Unit they were not aware that patients were not being accepted by General Practitioners in the area mentioned.
There is a facility whereby the HSE may assign an eligible person to be included in a medical practitioner’s list in the case of a person who has unsuccessfully applied to all those medical practitioners or to at least three of them, whichever is the less, who have entered into agreements to provide services in the area.
If a particular Medical Card patient has difficulty in accessing a GP in the area they should be advised to contact their local Primary Care Unit, which for the area in question is located at Block E Second Floor, Westland Park, Nangor Road, Dublin 12.
I trust this clarifies the issues raised and please do not hesitate to contact me should you require further clarification.
Assistant National Director – PCCC (Contracts)