A GP practice in Dublin's north inner city with more than 2,500 patients has said it is facing closure, despite assurance by the Government during the General Election that their issues would be "sorted".
The charity GP Care For All opened in Summerhill in 2015 to cater for the large number of medical card holders in one of the most deprived and diverse parts of the capital.
The service says that as it operates as a charity, it is being taxed on the double, making the business unsustainable.
Dr Bríd Shanahan said the issue relating to the tax status is complicated but it has become a distraction and a source of anxiety for her and her colleagues and if it is not resolved by June they will have to close the service.
"The doctors here are employed by the charity. Before this change in tax law, in most practices what happened is the income from the medical card contract would go to the practice and then the practice would pay the GPs.
"But with this change in tax law, the money has to go directly to the GPs. So the GPs are taxed directly under that, but we are PAYE employees of the practice, so we have to pay that tax as well.
"Our charitable model means that all of the profits from the practice go back into the practice and helping improve the standard of care for the patients.
"We would like to see an exemption, especially for practices that have charitable status, so that we can all continue to provide that level of care that's needed for our patients."
Dr Shanahan said the needs in the area have grown over the decade, as have the challenges of providing services to those with a variety of complex needs in multiple languages.
"It is an area of significant deprivation. When we started here in 2015, Gardiner Street was mostly youth hostels and B&Bs. All of that accommodation is now dedicated to homeless accommodation, mostly for homeless families. So a large number of our patients are living in homeless accommodation.
"The average age of death for our patients is 60, and that's down to patients developing ill health at a younger age. We see patients with conditions like heart disease, COPD and cancers in their 40s and 50s, whereas those things would develop in maybe people in their 70s and 80s in other populations.
"A lot of the resourcing for those conditions only kicks in when a patient hits 65 so we have far higher complexity of patients. The patients have more need."
The practice actually has the funding to hire another doctor that could take on around 1,500 new patients, but GP Care For All said it cannot do this while its tax situation is unresolved.
Local TD and Labour Party Spokesperson on Health Marie Sherlock said the Department of Finance needs to act to save the service from closure.
"No 'for profit' GP practice would set up here such are the nature and the conditions of those who need GP care in this community. The Department of Finance, it's within their powers now to step in, to allow this medical charity to continue.
"It would be absolutely beyond devastating to see this practice close up, and it's unconscionable that the Government of the day would allow this practice to fold."
Terry Fagan, who is in his 70s, lives around the corner from the practice and is concerned about what might happen next.
"To hear that this possibility of it closing up - it's a shock. To lose this would be devastating for the community. It can't happen. What would we do? It would leave people scared. How will they find another doctor. Who is going to look after them?"
Revenue and the Department of Finance say they did not change but rather clarified how medical card income should be taxed.
"On becoming aware of practices whereby some GPs treated income received under their GMS contract as income of a medical practice in which they were a partner or an employee, Revenue issued guidance in 2023 to clarify the correct tax treatment of such income under the law."
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They say they delayed enforcing the rules until 1 January 2024 to allow practices time to adjust. They say on the same date a section of the 2023 Finance Act was updated in relation to the issue.
The charity said this change has left them at a disadvantage.
During the General Election, the then minister for health Stephen Donnelly said the issue had been "sorted".
Now the Department of Health and the HSE say they have offered advice and a number of solutions to GP Care for All.
"The solutions identified are in line with tax legislation and the provisions of the Health Act and GMS Contract. Those solutions are practical and implementable and would allow the organisation to continue its operation in line with all relevant legislation and the GMS contract."
But the charity said the HSE itself has rejected two of these models and that a third is not feasible for them.
So it said that if no resolution is found by June, it will have to close its doors.
The Department of Health said it will continue to engage with the charity on the issue.
"The HSE continue to support the GP Care for All practice and both the Department and the HSE will continue to engage with GP Care for All to implement a sustainable structural model to deliver services in line with all relevant legislation."
HSE CEO Bernard Gloster, meanwhile, said that he was confident there is no need for the service to close.
"I am concerned at the public confidence issues that could arise from these reports. I am confident that there is no need for that service to close and the HSE has offered every support to ensure that won't happen.
"I have asked the National Director who heads up GP contracting to engage with them this week to offer them every assistance necessary, and I have met them myself previously," Mr Gloster said.
