GPs who wish to sign up to the new agreement providing free GP care for children under six have been asked to return signed contracts as soon as possible.

The HSE intends to commence free GP care for under sixes from July 1. It is up to each individual GP whether or not so sign up to the scheme. However, those who choose to opt out face losing many of their child patients.

The contract document, providing for free GP care as well as 'wellness' checks and an asthma treatment programme for children under six, is being sent to all 2,500 GPs in the country.

Separate to the provisions of this contract, a new diabetes treatment programme for all medical card and GP visit card patients is expected to be introduced in the autumn, while free GP care for all over 70s is also set to be introduced.

GPs are set to be paid €125 per annum per child patient under six under the new contract. This compares to an annual fee of around €75 for children in a similar age group in the current medical card scheme.

Taking allowances and pension payments into account, the fee would rise to just over €200 for many GPs. The contract follows recent negotiations between the Government and the doctors' union, the IMO.

For the asthma treatment scheme, GPs, in addition to the normal €125 under sixes payment, will get a special €50 patient registration fee plus €90 for two visits in the year post-registration, followed by an extra €45 for asthma treatment in each subsequent year.

GPs will also get extra payments under the diabetes scheme when it is introduced.

The wording of the contract document indicates how GPs stand to lose many of their existing private under sixes patients, as well as their existing medical card under sixes, if they refuse to sign up to the free treatment scheme.

The contract states that a GP shall ordinarily accept onto their panel all under sixes patients whose parents request this. The HSE can, where a GP refuses to take on these patients through not signing up to the under sixes contract, assign the patient to another GP.

In cases where no other GPs in the area are willing to take on under sixes under the new scheme, the HSE can then direct a GP in the area to take on such a patient.

As the new contract will subsume the contractual arrangements currently in place for medical card patients under six, GPs who refuse to sign up for the new agreement face losing these patients as well as any private child patients they currently have who want to avail of the free under sixes scheme.

The other GP union, the NAGP has indicated that it may legally challenge any such move. It is currently reviewing the contract document and has advised its members not to sign up to the deal until it completes its review.

The Irish College of General Practitioners also says it is reviewing the contract document.

Its says while it welcomes moves to implement free GP care based on need and not income, it has concerns about the consequences of increased demands on GPs likely from the selected patient groups covered under the new arrangements.

Under the new scheme, existing under sixes full medical card patients will continue to get free GP care and free medicines, while existing GP visit card under sixes will continue to get free visits. New under sixes patients, who would currently have to pay a fee for GP care, will receive free GP visits but will still have to pay for medicines - ion other words they will get the same service as current GP visit card patients.

The contract document states that the under sixes contract is an interim agreement which will be replaced by an overall GP contract to be agreed between the Government and the IMO.

This contract, in addition to covering the new under sixes scheme, will also provide for a further extension of free GP care to other age groups, leading ultimately, it is planned, to free GP care at the point of access for the entire population.

If a new overall GP contract is not agreed by the late July of next year, a review of the under sixes contract will be commenced

While there are concerns about a substantial minority of GPs not signing up to the new agreement, the financial and practical consequences of following such a course of action may ultimately persuade many wavering GPs to join the under sixes scheme.

Due to competition law restrictions, the IMO cannot ballot its GP members on the deal or recommend acceptance or rejection of its terms.

The registration process for under sixes under the new scheme will start in early June , according to the Department of Health. Patents will be informed in the coming weeks how to register child patients under the scheme.

If a child already has a full medical card of GP visit card, their parents will not need to register for the under sixes scheme.