More than €90 million was paid out in “duplicate” fees to general practitioners related to the Covid-19 pandemic for services already covered by the existing general medical services (GMS) scheme, the Department of Public Expenditure has maintained in a new spending review.
However, the Irish Medical Organisation (IMO) insisted that this assertion was incorrect and that Covid-19 was not covered by the existing GMS contract. It said telephone triage of patients who may have had Covid was a new service.
The spending review, published on Thursday, states that €797 million was paid overall in fees and allowances to GPs last year. It says about €169 million of this related to dealing with Covid-19 while €628million could be classified as “core” expenditure under the existing State medical schemes.
It says the response of general practice was vital in addressing the pandemic. However, it also says “additional expenditure on GP fees and allowances contributed approximately €200million to the State’s borrowing requirement in 2020”.
It says much of the increase in payments was due to emergency fees, “which should be time-bound by legislation and subject to constant review”.
The spending review says some payments to GPs represented a duplication with respect to services already provided through the GMS payments – “an estimated €92million in 2020 with some element of this repeating in 2021”.
The report specifically points to the introduction of special fees for GPs to provide telephone triage for patients at the onset of the pandemic when attendance by patients at doctors’ surgeries was discouraged.
It says it was agreed that GPs would be paid €30 from March 16th last year for each telephone Covid-19 triage conducted for both private and public patients even if the GP was already being reimbursed for the public patient through existing GMS capitation.
“This had the effect of the exchequer paying telephone triage costs for [medical and GP visit] cardholders who would have previously been triaged from within the existing funded GMS scheme – ie, a duplication of costs.
“It is estimated this duplication amounts to some €23 million in 2020 (ie 44 per cent of claims were by public patients).”
‘Uncertain rationale’
The review says a payment of €25 was also introduced for public patients for remote consultations not related to Covid-19.
“However, the rationale for this additional payment was again uncertain as it applied exclusively to public patients already covered under the GMS scheme. In effect, the exchequer was reimbursing GPs with an additional payment for virtual consultations with medical or GP visit cardholders where previously a physical consultation would have been covered under the capitation and other payments already paid under the scheme .
“The initial activity assumptions underlying these demand-led fees foresaw a three-month budget of €17.5million but this was quickly surpassed before these fees ceased to apply in August 2020. The final cost was €69 million for almost 2.8 million triages.”
The IMO said at the start of the pandemic the Department of Health and the HSE were anxious to introduce supports to ensure that general practice remained open.
“In relation to the telephone triage support for GMS patients, it was recognised by the parties that this was a short-term measure to ensure GPs and their teams could adapt quickly and ensure patients could be managed in an environment where they were not in a position to come to the surgery due to the pandemic restrictions. This was a short-term measure for a specific period in 2020 and did not extend into 2021.”
‘Not covered’
The IMO said GPs had been asked to establish the new Covid triage system, which was not covered by the existing contract. It said this had facilitated the following of disease trends in the community.
The spending review also says that the policy rationale for a separate €9 million “winter support grant” introduced as a once-off payment to GPs “remains ambiguous”.
It says that in 2018-2020, GP fees and allowances increased overall by 45 per cent. However, about 70 per cent of this increase was related to the pandemic.
A further €80 million was linked to the introduction of a new contract with GPs that saw them receive additional payments in return for co-operation with agreed service developments and reforms such as relating to chronic disease management. This new deal was aimed at generating savings on costs in hospitals.
The review says payments to GPs are likely to remain elevated into the future.
A further €130 million under the revised contract agreement reached with family doctors in 2019 is due to be paid by 2023.
The review also says that “the requirement for a triaging system as part of the State’s Covid-19 testing and tracing plan is still uncertain whilst Government has agreed that the extended influenza programme will continue in winter 2021-2022”.
