Thursday, 26 January 2012
Dáil Éireann Debate
Deputy Simon Harris: I thank the Minister of State, Deputy Jan O’Sullivan, for responding to this matter. I congratulate her on her promotion. I am pleased to have the opportunity to raise in the House the need to re-examine the current system of issuing prescriptions in light of what I believe are inefficiencies and inequities created by requiring GPs to reissue all prescriptions from hospital consultants, in particular in the area of mental health services for medical card holders.
As the Minister of State will no doubt be aware, the roll out of primary care centres was discussed at the Committee of Public Accounts in great detail this morning. I believe wholeheartedly, as does the Government, in the rationale behind the move to primary care centres and the need to ensure we can treat as many patients as possible within their own communities, in an effective and streamlined manner.
The programme for Government commits to an ambitious programme of reform in this area, one which is essential to the delivery of the best possible standard of health care in this country. The progress made last year by the special delivery unit shows that advances can be made even at a time when the health service has to face severe financial cutbacks. To do this, it is essential that all resources are utilised in the most effective manner possible. It is in this wider context that I wish to raise the need to re-examine the way in which prescriptions are issued to medical card holders.
I have been contacted by many constituents frustrated by the system currently in place, where families attending hospital or psychiatric services have to revisit their GP in order to get their prescription re-written as a GMS order to access their entitlement to receive it for free. This is most pressingly a problem in the case of prescriptions. Mental health prescriptions are obviously prescribed for very good reason, and often require individuals to take them consistently over a prolonged period. Depending on the circumstances, prescriptions for these long-term medications are sometimes issued on a weekly basis, requiring the patient to visit the GP for a GMS order every time a prescription is required.
Some modern health medications for treating conditions such as autism can cost up to €300 per month. If parents are not in a position to see their GP, as I understand was a concern for some families over the Christmas period, they may not be able to afford the cost of the prescription. That has real consequences for the children and families concerned, and pharmacists have little or no discretion in issuing such prescriptions without a separate GMS order. The system appears to be extremely bureaucratic. I would appreciate if the Minister could outline the rationale behind having GMS orders issued in this way, given that it appears to result in a duplication of resources. Patients see a specialist in a particular field, who prescribes the medication they feel is most suitable. They then have to revisit their GP in order to obtain a GMS order for the prescription. This same process takes place when a prescription is issued by a hospital. That is causing widespread waste of time and inefficiencies and is wasting the time of doctors at a time when the health service is clogged up. I am informed that while hospitals can use a special form to issue a prescription for up to seven days, in practice this is often not used. It is not the most practical measure. The current system can result in additional, unnecessary visits to GPs. I look forward to engaging with the Minister on the matter.
Deputy Jan O’Sullivan: The Medical Council’s guide to professional conduct and ethics states that “it is in the best interests of the patient that a general practitioner, GP, supervises and guides the overall management of their health”. There are approximately 2,600 GPs in active practice, of which approximately 2,300 hold a contract with the Health Service Executive, HSE, for the provision of services under the general medical services, GMS, scheme to medical card and GP visit card patients. Approximately 40% of the population is covered by the GMS scheme. GMS contracted GPs undertake to provide their patients with all proper and necessary treatment of a kind generally undertaken by a GP. That includes the issuing of a prescription for medicines or drugs as is determined to be necessary by the GP for his or her patient.
Since 1996 there has been an arrangement under the GMS scheme for the emergency supply of medicines for medical card holders on discharge from hospital. Community pharmacists participating in the GMS scheme are authorised to dispense a maximum of seven days’ supply of medicines prescribed for persons who have been inpatients in a hospital or who have attended an accident and emergency department and because of the circumstances of their discharge and-or the urgency of the prescribed medication it would not be possible to attend their general practitioners to have the hospital prescription transcribed to a GMS prescription form. This arrangement relieves any difficulties that patients might encounter who are due to be discharged from hospital late in the evening or at weekends.
I believe that the Deputy is raising this matter, as he indicated, in the context of recent changes to the supply of medicines to some mental health patients in the area of the former Eastern Regional Health Authority. In line with the Health Service Executive’s stated policy to standardise and streamline arrangements under the State drug schemes, to improve equity for service users and increase efficiency, local services have been advised to direct medical card holders requiring psychiatric medicines to attend their local general practitioner. This approach aligns the arrangements for the dispensing of drugs and medicines to persons on medication for a mental health condition, who reside in the greater Dublin area, with the arrangements that pertain in the case of persons living in all other parts of the country. This is also consistent with the arrangements for dispensing drugs and medicines across the full spectrum of medical conditions and is consistent with the policy of normalising and de-stigmatising this aspect of our health care service. It is also consistent with the key recommendations in A Vision For Change, the report of the expert group on mental health policy, pertaining to the treatment and care of mental health conditions in the primary care setting where it is acknowledged that treatment in this setting “enables the largest number of people to get easier and faster access to services”.
This initiative ensures that general practitioners have a full involvement in their client’s medications, including their psychiatric drugs. The process also ensures that pharmacists, who continue to provide this medication to eligible persons under the various scheme arrangements, can claim reimbursement in respect of these drugs with their other monthly submissions. These claims will be reimbursed by the HSE at the tariffs set by the Minister for Health under the applicable regulations. This change will not disadvantage medical card holders and it will reduce the administration associated with these arrangements and free up resources for other patient services.
In summary, I assure the Deputy that it is best clinical practice that a person in need of treatment should regularly attend their GP and that the GP is fully aware of the medications that any patient may be being prescribed. This is entirely consistent with the gatekeeper role played by the GP in the delivery of primary care. Furthermore, due to the reimbursement arrangements under the GMS scheme whereby a GP is paid a capitation fee per eligible patient on their list, there are no additional costs associated with an eligible patient attending. Rather, the rationalisation of previous local arrangements to fit with the national arrangements provides obvious administrative savings and increased efficiencies.
Deputy Simon Harris: I thank the Minister of State for her comprehensive reply. I am sure she will not mind me respectfully disagreeing with much of it. I cannot accept that this is best practice when it is a practice that only applies to medical card holders. If a private patient seeks psychiatric medical attention in the morning, he or she will get a prescription, go to the pharmacy, pay for the prescription and go home. If patients with medical cards seek prescriptions, they attend their mental health specialists, for wont of a better phrase, and get their prescriptions, which are useless to them for accessing medication. They must then attend their GP and endure the difficulty associated with getting appointments and waiting times in some areas. It is only then they can go to their pharmacies. All of this adds an additional layer of bureaucracy and inconvenience for medical card patients. Were the process standardised across the board, the response would have some credibility but that does not seem to be the case.
I welcome the fact that there is no extra cost but there is an extra inconvenience to patients. I value the role of the GP and the answer made a great deal of sense in that respect. We are all on the same page, in that we want to move to a situation in which mental health care is received in the community. Ideally, the GP should be situated in the same building.
This situation needs to be examined in light of the great technology that exists. We saw how Revenue could have used it to good effect in respect of pensioners recently. Computers should be able to talk to one another. The areas in question, for example, autism, are often specialties and specialists would be the best people to monitor the situation.
It risks stigmatising those on the General Medical Services scheme with mental health difficulties. There is an issue and I would appreciate it if the Minister of State relayed my comments to the Minister for Health.
Deputy Jan O’Sullivan: I will. The Deputy has made a good argument on the other side. I am not the Minister directly responsible but the notes I have been given state that the arrangements will be kept under review. That the Deputy’s voice might be listened to might give him some comfort. There are reasons for taking these measures. I understand the Deputy’s points and I will convey them to the Minister.
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