Press Release

Ministers welcome Agreement with IMO on Free GP Care for Under-6s

Ministers welcome Agreement with IMO on Free GP Care for Under-6s

– Extension of free GP care to everyone over 70

– Introduction of diabetes cycle of care

Minister for Health Leo Varadkar and Minister for Primary Care, Social Care & Mental Health, Kathleen Lynch have welcomed the agreement between the Department of Health, the HSE and the Irish Medical Organisation on terms for the delivery of free GP care for all children aged under 6.

“This agreement represents the first step in the phased introduction of a universal GP service without fees.  The commencement of this service this summer will make a real difference to the lives of the youngest in our society.  This new contract will also mark a shift towards promoting health and wellbeing and away from the old “illness model”.  It underlines the Government’s commitment to enhancing primary care and keeping people well in the community” said Minister Lynch.

Minister Varadkar said: “This agreement is a major step forward in improving access, quality and affordability of health care in Ireland. It also marks the most tangible step forward so far along the road to universal health care.

“From this summer, up to 300,000 children and senior citizens who currently have to pay to see their GP will no longer have to. This will mean real savings for pensioners and families. But it is about much more than that. The new enhanced service covers all children under six including those who have medical cards already.  They will benefit from management of asthma in general practice and preventative wellness checks. Adults of all ages will benefit from the new diabetes programme, meaning they will have their condition managed by the GP who knows them, rather than in the hospital clinic.

“I want to thank the IMO for their leadership in coming to this agreement and I firmly hope all GPs sign up to this new improved and expanded primary care service,” the Minister added.

The HSE National Director for Primary Care, Mr John Hennessy, said “The measures announced today will remove significant barriers to access and provide a boost to the management of chronic illness in primary care settings, near to patients’ homes and in accordance with modern, evidence-based clinical programmes. The focus on good health and illness prevention for young children is also a major step forward and an investment in health and wellbeing for future generations.”
Under the new arrangements, an additional 270,000 children under 6 will benefit from GP care free at the point of service. All children under 6 will benefit from the new enhanced service under the proposed GP contract. This will involve age-based preventive checks focused on health and wellbeing and the prevention of disease. These assessments will be carried out when a child is aged 2 and again at age 5, in accordance with an agreed protocol.  The contract will also include an agreed cycle of care for children diagnosed with asthma, under which GPs will carry out an annual review of each child where the doctor has diagnosed asthma.

The extension of GP care free at the point of service to everyone aged 70 or over and who does not currently qualify for this benefit will take effect at the same time as the under-6 service, subject to the enactment of the necessary legislation.  The Health (General Practitioner Service) Bill 2015 is due to be introduced in Dáil Éireann on 15 April.  This service will benefit about 36,000 new patients and will be provided under the existing contractual arrangements for this age cohort.

The negotiations with the IMO have also resulted in an agreement on the introduction of a Diabetes Cycle of Care.  This will enable patients with a medical card or GP visit card and who have Type 2 Diabetes to avail of two annual visits to their GP practice for a structured review of their condition. This service will begin in Quarter 4 of this year.  This initiative will help to integrate care across the continuum of care, will improve clinical outcomes for patients and reduce complications often experienced with this condition.

Minister Lynch added: “The developments which have been agreed through intensive engagement between the Department of Health, the HSE and the IMO lay the groundwork for a wider and more appropriate range of services to be provided through primary care.  I look forward to further progress being achieved in the discussions on the GP contracts generally, which have begun in recent weeks.

Notes for Editors

The Government’s Statement of Government Priorities 2014-2016 reiterated the commitment to the introduction of a universal GP service for the entire population, in line with the Programme for Government.  The Government has prioritised children under six and people over 70 in the first two phases of the roll-out of universal GP care.

Following the signing of a Framework Agreement in June 2014, there has been intensive engagement between the Department, the HSE and the IMO on the contract for GP care free at the point of access for the under 6s.  Agreement has now been reached between the parties, which will allow this to become effective in the summer.

In parallel with this, GP care without fees will be provided for all persons aged 70 years and over under the existing GMS contract.

The HSE will issue contracts for the under-6 service to GPs in the coming weeks.  The HSE aims to commence patient registration during May, so that all the arrangements for the commencement of the service can be completed by the end of June.

Under-6 GP Service
The Health (General Practitioner Service) Act 2014 provides the legislative basis for the under-6 service.

Having considered the outcome of the discussions with the IMO, the Minister for Health has determined that an annual capitation rate of €125 per patient shall apply, with enhanced capitation payments in respect of children covered by the asthma cycle of care, at €50 for year of diagnosis and €45 for each subsequent annual check.

Asthma Cycle of Care
Asthma is a chronic disease that is often poorly controlled in children. As a consequence children often cannot lead normal lives due to symptoms of breathlessness and cough. International evidence shows that management of asthma in primary care with a particular emphasis on self-care greatly improves the quality of life for children with this disease.

The asthma cycle of care will provide the key elements of best practice in the care of asthma with structured visits including education of child and parents, medicine and inhaler technique review and an individualised asthma plan for parents.

It will result in better quality of life for children, with resulting better health and wellbeing and less need to visit hospital.

It is estimated that in a full year, the additional cost of the universal under-6 service, including the preventative wellness checks and arrangements for management of asthma in general practice, will be approximately €67m.

Over-70s GP Service
The Health (General Practitioner Service) Bill 2015, the debate on which will begin shortly in the Oireachtas, will provide the statutory basis for the over-70s service.

The new over-70s service will benefit approximately 36,000 people who currently pay to attend a GP as they are not covered by a medical card or a GP visit card.

The cost to the Exchequer of the proposed legislation for a universal over-70s GP service is estimated at €18 million in a full year. This service will be provided under the existing GMS GP contract and there is no change in GP fees in respect of this service development.

Diabetes Cycle of Care
In February 2015, a Memorandum of Understanding was agreed between the Department of Health, the HSE and the IMO in relation to negotiations on a comprehensive new GP contract. The list of issues within the scope of these negotiations included a range of enhanced structured services for Chronic Healthcare Management.

It has now been agreed that a Diabetes Cycle of Care will be introduced for GMS and GP Visit Card patients with Type 2 Diabetes. This will provide structured care for this condition for patients in this category, on the basis of two specific visits per year to review the patient’s condition.

GPs will be paid a registration fee in the first year at €30 per visit, with enhanced capitation payments to reflect two annual visits at €50 per visit. The clinical content of this service has been agreed between the parties and participating GPs will be required to submit appropriate data to the HSE to enable the effectiveness of the arrangements to be monitored and assessed.

The detailed arrangements in relation to this service will be finalised between the parties over the coming weeks, in order to enable this service to begin in Quarter 4 of 2015.

The costs associated with this initiative are estimated at approximately €4.5m in 2016.