asked the Minister for Health whether all general practitioners operating under the General Medical Service are being paid on a capitation basis; the effect of the legal challenge by members of the General Practitioners Association who are seeking to be still paid on a fee per item basis; if he is satisfied that the revised contract has had the desired effect of curbing the growth in the cost of the General Medical Service; and the response he has to claims by some general practitioners that they signed the new contract under duress.
Ceisteanna—Questions. Oral Questions. - General Medical Service Scheme.
6.
Out of 1,571 doctors participating in the General Medical Services Scheme, 1,499 are remunerated on a capitation basis.
Regarding the matter of the High Court action, I presume the Deputy is referring here to the legal action taken by a particular doctor concerning the continuance of her GMS contract. As a result of the High Court judgment the particular doctor has the right to continue to provide services to eligible persons in accordance with the terms of the 1972 GMS contract. On the same basis, a further 71 doctors continue to provide services in accordance with the terms of the 1972 contract.
In relation to the new terms and conditions for medical practitioners participating in the scheme, I am satisfied that Mr. Horgan's recommendation represented a sound basis for the development of general practice, for achieving a more efficient and effective delivery of practitioner services and to enable the cost of the scheme to be brought under control, allied to a more cost-effective use of the resources committed to the GMS. The Deputy will understand that the new arrangements have only been in operation for a few months. Furthermore, all elements of the new arrangements are not yet fully operational. It is, therefore, too early to make conclusive judgments in relation to expenditure trends under the scheme.
As regards alleged claims by some doctors that they signed the new contract under duress, I have no evidence which would substantiate such claims.
Would the Minister not agree that there is a £25 million over-run on the GMS budget; that the expected savings by the revised contract have not materialised; that there is now, in effect, a two-tier operation of the scheme arising out of this court case whereby some doctors are on a fee per item basis and others are on a capitation basis, and that the whole purpose of this scheme was to get everybody on capitation and this has failed?
No, I do not accept what the Deputy is saying. Features of the GMS in 1989 gave rise to the expenditure which will be the subject of a Supplementary Estimate this evening. First, the scheme did not come on stream until April; it did not come on stream at the beginning of the year. There was a once off payment to doctors who formerly were paid three months in arrears. Because of the nature of the fee for service payments and processing of them, they are now paid at the end of each month. That added £8 million to the cost of the scheme. There was a significant increase in expenditure on drugs and medicines, some of it because of an increase in the price of drugs and the scheme was in operation for three months of the year. As the Deputy is aware, it was a demand led scheme and there was an increase in the number of drugs prescribed in the earlier part of the year. I am satisfied that when the scheme settles down we will see the benefit in terms of a reduction in the number of prescribed drugs.
Will the Minister acknowledge that some doctors operating this revised contract in urban areas such as Tallaght and Cork Central have higher visiting rates than the national norm? Will he now seek to make proper provision for those doctors who have costs over and above what is normal for general practice?
Negotiations on how doctors will be remunerated for their work were held with the Irish Medical Organisation who were satisfied——
They were very dissatisfied.
They were satisfied. It was negotiated very freely with them and the money was made available. How that money would be divided between the doctors was the subject of long, extensive negotiations with the IMO and they had no complaint at the time. However, the scheme is due for review and if the IMO want to put forward a different way of remunerating the doctors within the resources available, we will examine it.