The current General Medical Services (GMS) General Practitioner (GP) Capitation Contract was introduced in 1989 and is based on a diagnosis and treatment model. Under the GMS contract, GPs receive a range of fees and allowances, including an annual capitation payment in respect of each medical card and GP visit card patient on their GMS list.
Under the Financial Emergency Measures in the Public Interest (FEMPI) Act 2009, an 8% reduction in a range of GP fees and allowances was introduced in 2009, which effected full year savings in the region of €34 million. Further reductions to a range of fees and allowances were introduced in 2010, which effected full year savings in the region of €44 million. This equates to an approximate additional reduction of 9%.
Following a further review and having due regard to Section 9 of the FEMPI Act 2009, the Minister for Health has decided to apply further reductions to the fees and allowances payable to GPs which equate to an overall reduction of 7.5%. This will amount to a saving of some €38 million in a full year. Regulations are being prepared to give effect to the Minister's decision.
The Programme for Government provides for the introduction of a new GMS GP contract with an increased emphasis on the management of chronic conditions, such as diabetes and cardiovascular conditions. It is envisaged that the new contract, when finalised, will focus on prevention and will include a requirement for GPs to provide care as part of integrated multidisciplinary Primary Care Teams. The appropriate payment arrangements will be considered as part of the new GMS contract.
Capitation fees are paid to General Practitioners where a person has eligibility for a Medical/GP Visit Card. Fees are not paid where eligibility no longer exists e.g. following an assessment of their means, emigration or death. Under the Health Act 1970, there is an obligation on all card holders to notify the HSE of any change in their circumstances, which would put them above the Medical Card/GP Visit Card income guidelines.
In addition to the normal three-yearly review of eligibility on expiration of a medical card, targeted reviews of eligibility were introduced during 2012, in relation to medical cards which had been inactive for more than 12 months. In such cases, medical card holders were formally contacted to confirm that they were still resident in the State. In cases where no response was received, eligibility was removed and the payment of capitation fees ceased. A person whose eligibility is under review who appeals a decision regarding their eligibility retains their original eligibility until an Appeal decision is reached.
