Minister for Public Expenditure Paschal Donohoe had strong concerns about elements of the Government's initiative to provide free GP consultations to people seeking advice or testing in relation to Covid-19.
The Department of Public Expenditure said on Tuesday the scheme was expected to cost about €110 million. Newly-released official documents show Mr Donohoe expressed fears that the initiative could effectively lead to the State facing uncapped levels of expenditure.
The agreement on an emergency GP fee structure under which family doctors would provide such services without charge was reached between the Government and the Irish Medical Organisation (IMO) in mid-March. Under the deal GP s were to be paid fees ranging from €25 to €75 depending on the particular service provided.
New documents show that Mr Donohoe wrote to Minister for Health Simon Harris with concerns about the scheme in late April. *
In a letter dated only as March 2020, Mr Donohoe said that while he noted and accepted “the pressing rationales that have been advanced in terms of mobilising, supporting and partnering with general practice”, his department had raised “significant concerns regarding the high unit costs and activity assumptions underlying what are, in essence, uncapped Exchequer commitments”.
The letter notes that when sanction was first given “for these extraordinary measures”, it was on the basis of a 13-week period.
“ I note that the Statutory Instrument, as presented yesterday by your department, does not in itself reflect the time-bound nature of the sanction. I would like to reiterate what I believe is an agreed position, that these exceptional measures cannot be rolled over as a matter of course after the expiration of the 13-week period, and that any proposal to extend will require my approval as well as clarity on the ongoing costs,” Mr Donohoe wrote.
“I understand that the new fee structure have been in operation since March 16th, and there is still no official indication as to whether the assumed activity levels underpinning the costs are realistic.”
Resources
Mr Donohoe said that given the scale of new demand for resources required elsewhere in the Department of Health and in other areas of Government, he wanted to re-emphasise "the importance of monitoring the uptake and effectiveness of these expenditure measures with a view to ensuring that costs – which are necessarily subject to some uncertainty – are contained within proportionate and affordable bounds".
Mr Donohoe said he wanted “serious and constructive” engagement before the end of the 13-week operation of the scheme.
On April 28th, the original letter from Mr Donohoe was again sent to Mr Harris, repeating the same points.
The documents do not reveal what response, if any, Mr Donohoe received from the Minister for Health.
Medical sources said that following a review earlier this month the scheme had now been extended – with some amendments to the terms – until August 10th. It is understood that provision for an additional fee if a GP saw a patient in their surgery outside of normal hours has been removed.
The original estimated cost was €110 million, and it is envisaged the extension can be accommodated within this.
* This article was amended on June 24th, 2020
