Dáil Éireann Debate, Wednesday - 22 October 2014
119. Deputy Brendan Griffin asked the Minister for Health the savings achieved by the abolition of the rural allowance for general practitioners under the FEMPI legislation; if he will provide a breakdown of the county spend on this allowance over the final five years of its existence if possible; if he will provide details of the number of recipients per county; and if he will make a statement on the matter. [40531/14]
View answer124. Deputy Brendan Griffin asked the Minister for Health his views that there is a lack of incentive for general practitioners to take up practice in rural areas; and if he will make a statement on the matter. [40542/14]
View answer125. Deputy Brendan Griffin asked the Minister for Health if his attention has been drawn to cases where general practitioners cannot be found to take up vacant positions in some rural areas; and if he will make a statement on the matter. [40543/14]
View answer126. Deputy Brendan Griffin asked the Minister for Health the way he plans to incentivise general practitioners to take up vacant positions in rural areas; and if he will make a statement on the matter. [40544/14]
View answer127. Deputy Brendan Griffin asked the Minister for Health his views that the scrapping of the rural allowance is directly linked to the growing problem where general practitioners cannot be found to take up vacant positions in some rural areas; and if he will make a statement on the matter. [40545/14]
View answerI propose to take Questions Nos. 119 and 124 to 127, inclusive, together.
Where a General Practitioner (GP), who holds a General Medical Services (GMS) contract, lives and practices in a centre with a population of less than 500 and where there is not a town with a population of 1,500 or more within a 4.83 km (3 mile) radius of that centre, the GP is entitled to a Rural Practice Allowance.
As a result of satisfying the criteria for payment of the Rural Practice Allowance, the GP is also entitled to claim practice support subsidies (Practice Nurse, Practice Secretary and Practice Manager) at the maximum applicable rate which he/she would otherwise only be entitled to claim if he/she had a panel size of 1,200 and over. The GP would also be entitled to claim the maximum applicable contribution towards locum costs for periods of sick leave, annual leave, study leave, maternity leave and adoptive leave. In remote areas, where an alternative to dispensing by the GP is considered not to be feasible by the HSE, a dispensing GP is entitled to receive payment for dispensing to his/her GMS patients.
The Rural Practice Allowance has not been abolished. Since 2009, a number of reductions have been applied under the Financial Emergency Measures in the Public Interest Act 2009 (FEMPI) to the fees and allowances paid to health professionals, including GPs who provide services under the General Medical Services (GMS) Scheme. Over this period, the Rural Practice Allowance under the GMS capitation agreement has been reduced from €20,712.29 to the current annual rate of €16,216.07. This has resulted in an overall reduction in the payments made by the HSE for this allowance from some €3.762 million in 2009 to approximately €3.121 million in 2013.
GPs contracted under the GMS Scheme are paid an annual capitation payment in respect of each patient on their GMS list. Up until 2010, this capitation payment was based on the patient's age, gender and the distance they lived from the GP's surgery. In 2010, under FEMPI, the aspect relating to distance from the GP's surgery was removed as a factor in calculating capitation fees. In this context, it should be noted that the 2010 Regulations imposed a variety of reductions across a range of fees and allowances averaging just over 9% in total. While the reduction in certain fees was more than 9%, the reduction in others was less than 9%. In making such determinations, the Department was mindful of information from the HSE which indicated that 90% of GP consultations take place at the GP surgery and do not involve a home visit – also many of the home visits are undertaken out-of-hours by GPs in co-ops, where the GP has the use of a car and driver funded by the HSE, which they can also use for home visits to private patients. The Department, in arriving at its final determination in relation to the range of percentage reductions also ensured that the reduction in relation to the superannuable fees was kept to a minimum, thus minimising the reduction in the GPs’ pensions at a later stage (superannuable fees were only reduced by 3.5%). In relation to the removal of “distance” as a factor in calculating certain fees, the total estimated full year saving for this measure in 2010 was €5.2 million.
While GP numbers are keeping pace with overall demographics, this does not always prevent shortages occurring at local level. GPs once qualified tend to work for existing GP practices or as self-employed contractors - and are free to decide where to establish practice. Isolated rural areas and deprived urban areas, very often with limited private practice opportunities, may sometimes find it difficult to attract GPs to fill vacant posts.
The HSE is actively seeking to address this issue at present with the medical organisations with a view to developing practical measures - including reorganising lists with existing doctors in local areas, and through the development of more flexible contractual arrangements which would encourage young GPs to work in such areas. This will be examined as part of the overall GMS contract discussions between the Department, HSE and the Irish Medical Organisation, which will begin shortly.
In relation to the particular aspect relating to the breakdown of spend by County for the Rural Practice Allowance, I have asked the HSE to respond directly to the Deputy on this matter.
