When the GMS scheme was introduced in 1972 it was a fee per item based scheme. However, following a review of the operation of the scheme in the mid-1980s the basic payment structure changed to an age and sex based capitation system, which also encompasses a superannuation element. It is an annual figure. General practitioners hold GMS contracts with the health boards for the provision of services to medical card patients. Extra premia are payable to doctors for out of hours services and for domicili ary visits. The medical card holder does not have to make any payment for these services. There are also a range of specific payments for particular services that co-exist with this capitation structure. Entitlements and arrangements in respect of pension and holidays are as per the provisions of the GMS contract.
The GMS scheme comes about as a result of negotiations with the Irish Medical Organisation which is the only body representing general practitioners to hold a negotiation licence. Agreements arising from these negotiations are translated into official Department circulars setting out the terms of the agreements for implementation at health board level. Full details of the general medical services contract are set out on the website: www.gpit.ie/egms.
Practice support allowances in the form of grants for secretarial or practice nurses are also based on the number of GMS patients on a doctor's panel. They are not intended to be the basis of the salary paid to the individuals involved. These salaries are a matter of contract between the doctor, as the employer and his or her employee.
My Department intends, through the HSEA, to enter into negotiations with the Irish Medical Organisation very shortly on the matter of the budget provision and the extension of the medical card to all persons aged 70 years and over. It is hoped that this will ensure that all procedures are in place to facilitate the implementation of the measure from 1 July, 2001.
