Dáil Éireann Debate, Tuesday - 17 April 2018
869. Deputy Niall Collins asked the Minister for Health the reason for the difference being quoted by his Department, the Department of Public Expenditure and Reform, the HSE and organisations (details supplied) as to the level of FEMPI cuts imposed on general practitioners; and if he will make a statement on the matter. [15850/18]
Amharc ar fhreagraUnder the General Medical Services (GMS) contract, GPs are reimbursed for a range of services they provide to medical card and GP visit card holders. GPs are remunerated for these services primarily on a capitation basis, with a range of additional support payments and fees for specific items of service. GPs are also remunerated for services they provide on behalf of the HSE under other public health schemes, such as the Maternity and Infant Care Scheme, Primary Childhood Immunisation Scheme, etc.
The Financial Emergency Measures in the Public Interest (FEMPI) Act 2009, imposed a range of adjustments to health contractor payments. These included different levels of reductions to various GP fees and allowances and the elimination of certain payments.
Despite reductions to the payment rates of health contractors made under FEMPI legislation, the total fees paid to GPs under the GMS scheme have increased during this period from just over €472 million in 2009 to approximately €517 million in 2017. This increase in fees is largely due to significant developments and investment in GP services introduced in recent years, with more services being made available to our citizens and additional financial support provided by the HSE.
The adjustments to GP payments made under FEMPI were introduced by Regulations made under the Act. In response to recent queries from the media, my Department has provided information on the fee adjustments, as set out as follows.
SI 262 of 2009 applied an 8% reduction to the range of GP fees and allowances payable under the GMS Scheme, the Maternity and Infant Care Scheme and the (Health Amendment) Act 1996.
SI 638 of 2010 applied reductions to a range of GP fees and allowances payable under the GMS Scheme, the Maternity and Infant Care Scheme, the Health (Amendment) Act 1996 and the HeartWatch Programme, which equated to an approximate overall reduction of 9% to payments under these schemes.
- A 50% reduction was applied to the capitation fee in respect of patients aged 70 years or more who reside in a private nursing home (approved by the HSE) for continuous periods in excess of 5 weeks.
- The “distance from the GP’s surgery” was removed as a factor in calculating capitation fees, which were standardised at the 0-3 miles rate within the various age and gender categories.
- The “distance from the GP’s surgery” was removed as a factor in calculating out-of-hours fees and new rates applied.
- The “distance from the GP’s surgery” was removed as a factor in calculating Special Type Consultation (STC) fees in respect of temporary residents, EEA visitors and consultations where a GP sees another GP’s patient in an emergency and a 5% reduction was applied to STC fees.
- The Fund for the Development of General Practice (introduced in 1993) was abolished.
- A 5% reduction was applied to payments in respect of the practice secretary/nurse/manager subsidy.
- An 8% reduction was applied to other payments, including special items of service; leave cover; locum expenses under the fee per item contract; dispensing fees; rural practice allowance; and payments under the Health (Amendment) Act 1996.
- An 8% reduction was applied to fees under the Maternity & Infant Care Scheme.
- A 15% reduction was applied to fees under HeartWatch scheme.
SI 556 of 2011 reduced the administration fees payable to GPs for childhood immunisations under the Primary Childhood Immunisation Scheme by 7.5%, and the fees for administration for influenza and pneumococcal immunisations under the GMS scheme by 33%.
In 2013, an overall reduction of 7.5% was applied to a range of GP fees and allowance. SI 278 of 2013 reduced the fee payable to GPs for administering the influenza vaccination to the same rate as the fee payable to pharmacists for administering the same vaccination. SI 277 of 2013 introduced the following measures:
- Elimination of the special fee payable in respect of discretionary medical cards.
- A reduction of 3.1% in respect of the following fees:
- Capitation Fees
- Supplementary Out-of-Hours Fees
- Asylum Seekers / Non EU Nationals.
- A reduction of 1% in respect of the practice nurse/secretary/manager subsidy.
- A reduction of 7.5% in respect of the following payments under the GMS scheme:
- Out-of-Hours fees,
- Special Type Consultations (STCs),
- Special Items of Services (excluding immunisations),
- Rural Practice Allowance,
- Dispensing Fees,
- Second Medical Opinion,
- Leave cover.
- A reduction of 7.5% in respect of the following payments paid to GPs under the General Medical Services (GMS) 1972 Fee-per-Item Contract:
- Fee-per-Item Consultation Fees
- Homes for the Aged Consultations
- Rural Practice Allowance,
- Locum Expenses & Practice Expenses,
- Special Items of Service.
- A reduction of 7.5% in respect of the following payments:
- Health Amendment Act 1996 (Hepatitis C patients),
- Maternity & Infant Care Scheme,
- HeartWatch Programme.
