I propose to take Questions Nos. 144 and 145 together.
Under 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 resulting in savings of approximately €120 million per annum.
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 €518 million in 2016. 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.
Following the publication of the Public Service Pay and Pensions Bill late last year, along with my colleague the Minister for Public Expenditure and Reform, I made it clear that Government is committed to engaging with health contractors on the revision of fees as provided for under this legislation.
In this context the Government is committed to engaging with the representatives of general practitioners on the development of a package of measures and reforms to modernise the current GMS Contract. The primary focus of this engagement will be on a package of measures and reforms which, if agreed, will result in an expansion in the scope of the service provided by GPs to holders of medical cards and GP visit cards.
I have engaged with my colleague, the Minister for Public Expenditure and Reform about the future resourcing of general practice. My officials are working with counterparts in the Department of Public Expenditure and Reform and the HSE to ensure that the engagement process with GP representatives, which is due to start in coming weeks, is fully focused on the priorities of the Government’s health reform agenda and measures which will contribute to addressing the strategic challenges facing the service. If the talks process is successful and agreement can be reached on reforms that will benefit both patients and GPs, there is potential for State expenditure on GP services to increase in the coming years.
Details of the adjustments to GP payments under FEMPI are 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.