Ceisteanna—Questions. Oral Answers. - General Medical Service.

15.

asked the Minister for Health if he will give details of the new payment method proposed for doctors participating in the General Medical Service; and if he will make a statement on the matter.

I have made arrangements for a copy of the proposed revised terms and conditions for medical practitioners participating in the General Medical Services Scheme to be sent to the Deputy.

The proposed revised terms and conditions are primarily based on a capitation method of remuneration, with an additional, but limited, range of payments based on a free-per-item method.

I am confident that the revised terms represent a sound basis for the further development of general practice, adequately meeting the requirements of doctors in terms of remuneration, superannuation benefits and entitlements to annual and sick leave and will facilitate a new style of general practice affording the doctor the opportunity to allocate more time to consult with patients, where appropriate.

I look forward to receiving the full commitment of the profession in developing general practitioner services in line with patients' needs, the priorities as determined by the health boards and in the context of the overall development of community-based services.

When will the new payment method be in force? Does the Minister propose to continue the old payment method for doctors who will not sign the new contract? Could the Minister give details of the remuneration given for the employment of a nurse and of a secretary?

On the question of when the service will be implemented, the doctors have been given until 22 February to return the contracts sent to them within the past week or so. There is a case pending by one of the doctors before the courts and I cannot anticipate the decision the court will make in that case. I therefore cannot say what the position will be with regard to that doctor's contract. In regard to the revised terms, as I said, the doctors will be remunerated on a capitation basis with additional payments in respect of night emergency calls, European Community patients and temporary residents, etc., on a fee-per-item basis. Provision is made by the State for 10 per cent of capitation earnings to be paid into a superannuation fund and the doctor will contribute 5 per cent of his capitation earnings to the fund, which will be run by the Irish Medical Organisation.

Members should note that the scheme is compulsory on doctors wishing to participate in the scheme. Doctors will also receive a contribution based on patient panel size towards the cost of employing locums for periods of study, annual leave and verified sickness absences. The cost of the new terms will come to £50 million in a full year. It is anticipated that the additional cost in respect of doctors' remuneration will be offset by a significant reduction in the volume of prescribing resulting from the expected reduction in unnecessary patient visits. To enhance the savings on the drug expenditure side a drugs formula will be introduced for doctors in the scheme with the agreement of the IMO. There is a £3 million development fund out of which money will be provided for nurses attached to doctors' surgeries and for secretarial assistance.

Will the Minister confirm that money paid for the employment of a nurse or secretary will be for the employment of somebody other than a member of the doctor's family? Will he agree that the State will spend an extra £14 million per year on doctors' salaries as a result of the introduction of this new scheme?

It will be more than that.

I will communicate with the Deputy about the first part of the question as I do not know who would be eligible for employment as a practice nurse or secretary. It appears that an extra £14 million will not be available for doctors' salaries because the cost of the GMS in 1988 was higher than had been anticipated at the beginning of that year. There has been a rapidly escalating cost over the years and, therefore, I am satisfied that it will not be £14 million over the estimated cost for 1989.

Has the Minister within the new scheme a provision to ensure that adequate GP cover is provided for medical card holders? Will he accept a scheme whereby medical card holders will only be taken at certain times of the day or certain days of the week in some practices?

It is a condition of working for the health service that doctors provide an adequate and proper level of service for their patients at all times and if they are not available that they ensure somebody will provide such a service.

What monitoring will be set up to safeguard the patients' needs in relation to Deputy Howlin's remarks? What provision is in the agreement to increase diagnostic services at GP surgery level? Are there any incentives within the scheme or is there a new contract for this?

I will communicate directly with the Deputy on those two matters to give him accurate information as I do not have it now.