Cuts in GP fees to stay

GENERAL PRACTITIONERS have seen their fees and allowances paid under the various State medical schemes reduced by €84 million as a result of cuts put in place by the Government over the last three years, the Department of Health has estimated.

However, the department has argued in a review that the impact of the cuts has been “greatly mitigated” by the on-going increase in the number of medical card patients. It said the number of such patients had increased from 1.352 million in January 2009 to 1.787 million in May of this year.

The review of the financial emergency measures, which allowed the Government to cut fees and was finalised at the end of June, recommended that there should be no additional reductions introduced. On the other hand those already in place will remain.

However, the department urged that the Health Service Executive’s primary care reimbursement service should be asked to carry out a further analysis in relation to a small number of GPs – about 11 – where overall income from the general medical service scheme had fallen by more than 7 per cent as a result of a previous decision to remove the distance from the doctor’s surgery in calculating capitation fees.

Among the measures introduced since 2009 were a 50 per cent cut in capitation fees in the medical card scheme for GPs in respect of patients over 70 in a private nursing home, lower fees in cases where patients were seen outside of normal working hours, an 8 per cent reduction in fees for special items of service such as suturing or removal of cysts as well as in locum expenses, rural practice allowances and payments for treating Hepatitis C patients under legislation introduced in 1996.

An 8 per cent cut has also been put in place in fees for the maternity and infant care scheme as well as a 15 per cent reduction in payments under the Heartwatch scheme. Subsidies for practice secretaries or nurses were cut by 5 per cent.

The distance of a patient from the surgery was also removed as a criteria for calculating capitation fees, out-of-hours fees and fees for special type consultations such as in respect of temporary residents, visitors from European countries or for the treatment of another GP’s patient in an emergency.

The Irish Medical Organisation (IMO), in its submission to the review, argued the cuts had damaged the ability of general practice to provide a full range of health services. It said the implementation of the cuts was inequitable and they had predominantly hit rural locations.

The IMO also maintained that a survey of GPs taken earlier this year indicated that 47 per cent were not likely to register a patient in a nursing home on foot of the fee cuts introduced.

The doctors’ trade union also said there was “a worrying trend” in that a significant number had said they would have to look at services previously provided to patients on a pro bono basis.

The IMO sought, at a minimum, for the department to look again at the cuts in fees for out-of-hours services and for treating patients in nursing homes. It also said the department should restore the provision for taking distance from the surgery into account when calculating fees or at least reintroduce it at a reduced rate.

However, in its recommendations on foot of the review, the Department of Health said in making previous cuts it was mindful that 90 per cent of GP consultations took place in the surgery and did not involve a home visit.

“Many of the home visits are undertaken out of hours by GPs in co-ops, where the GP has the use of a car and driver funded by the HSE, which they can also use for home visits to private patients.”

“The department, in arriving at its final determination in relation to the range of percentage reductions also ensured that the reductions in relation to the superannuable fees was kept to a minimum, thus minimising the reduction in GPs’ pensions at a later stage – superannuable fees were only reduced by 3.5 per cent.”

The department said it also should be recognised that the annual capitation fees in respect of a patient over 70 in a nursing home – €448.04 – compared very favourably with the €280.31 payment made in relation to a patient aged over 70 in the community.

The department also said that the removal of “distance” as a criteria for calculating capitation fees would generate estimated savings of €5.2 million in a full year.

It also said that 190 GPs were receiving a rural practice allowance of more than €17,500 a year where they lived and practised in areas with a population of fewer than 500 people or where there was not a town with a population of 1,500 or more within three miles.

The department also said there were more GPs operating under the general medical services scheme now – 2,313 than there were in 2009 – 2,136.

It said the IMO had contended that up to 60 per cent of gross turnover for GPs was taken up by fixed overheads.

However, the department said 60 per cent of the population saw their GP on a private basis.

It said there were no State restrictions on private fees, working hours or on the number of private patients a GP could see.

“Therefore, the State cannot be expected to make allowance for the full cost of overheads in what are essentially mixed public/private practices.

“Secondly, GPs are unique among healthcare contractors in terms of the level and extent of allowances that they receive from the HSE towards their practice costs including secretarial and nursing subsidies, leave cover, medical indemnity insurance etc.”