The Health Service Executive is paying out €110 million for a service which costs the North only €23.9 million to provide, according to Department of Health, writes MARTIN WALL
THE COST of providing GP out-of-hours services in the Republic is about four times that in Northern Ireland for the same number of patients, internal Department of Health documents maintain.
In a report to Minister for Health Mary Harney in December, the Department’s Primary Care unit argued that a GP out-of-hours service could be delivered to about 1.6 million people in Northern Ireland at a cost of about £20 million (€23.9 million) annually.
“At present, in the region of €110 million is paid by the HSE for the provision of an out-of-hours service to approximately 1.6 million GMS patients.
“Included in the €110 million are payments to GP out-of-hours co-ops for cars and drivers, which GPs can also use to provide an out-of-hours service to their private fee-paying patients, with no contribution to the State for this benefit.”
The report was drawn up by senior Department officials as part of the process which led to Ms Harney deciding in December to reduce or abolish some fees paid to GPs, with an estimated saving of €48 million.
As part of the measures introduced by Ms Harney, fees paid for treating persons over the age of 70 in a private nursing home were cut by 50 per cent; the distance a patient lived from a GP’s surgery was removed as a criterion in setting capitation fees; and changes were put in place for out-of-hours consultations which will reduce payments by 22 per cent.
Furthermore, payment towards the employment of practice nurses and secretaries was cut by 5 per cent; fees under the maternity and infant scheme were reduced by 8 per cent; and the general practice development fund was abolished.
In submissions to the Minister, the Irish Medical Organisation (IMO) and a number of individual doctors maintained that further cuts could result in practice staffing levels having to be reduced and existing services having to be discontinued.
The IMO contended that GPs believed that they had been targeted for more cuts than other professional grades – they experienced an 8 per cent cut in 2009.
The IMO also argued that GPs had fixed overheads of 40-60 per cent of gross turnover.
However, in a commentary, the Department of Health said it had no direct evidence to support the claim the IMO made about the scale of fixed overheads.
It also maintained that 62 per cent of people seeking GP services must do so on a private basis.
“The net point is that the State cannot be expected to make allowances for the full cost of overheads in what are essentially mixed public/private practices.”
The Department official said that in gross terms – not taking practice expenses into account – GPs were paid an average of €200,000 under the GMS in 2009.
“Having regard to the fact that public servants earning in excess of €165,000 had had reductions of 12 per cent and those earning in excess of €200,000 have had reductions of 15 per cent, a strong case could be made that GP fees should be reduced by similar percentages.
“However, it is accepted that, notwithstanding the points made earlier, some allowance should be made for practice expenses.”