FAMILY DOCTORS will continue to be paid almost €1,000 per annum for medical card patients over 70 who reside in private nursing homes, despite the recent discussions on a new fee structure for older medical card holders.
In addition, the retention of an added weighting for certain practice allowances for over-70s patients means that practices will benefit by €500- €600 per patient per annum overall.
It means the overall benefit of treating these patients is greater than the headline fee of €290 per patient, announced by the Government-appointed arbitrator, brought in to broker a deal following a public outcry over changes to the system in the Budget.
The details have emerged in a letter from the chief executive of the Irish Medical Organisation (IMO) to GP members, in which no reference was made to a ballot of members on the fee changes. Sources have suggested that Competition Authority concerns mean it is unlikely a ballot will take place.
IMO chief executive George McNeice told doctors the most critical outcome of discussions between it and the Department of Health was the Government's commitment to amend the Competition Act "to allow for direct negotiations with the IMO on all publicly funded primary care services".
"The importance of such a development cannot be overstated. This will allow for the agreed review of the GMS and publicly funded primary care schemes to proceed in due course without concern as to any possible competition law restrictions," he said.
However, it has emerged that because a three to one weighting for allowances to pay secretarial and nursing staff salaries has been retained by the fees arbitrator, the actual benefit to family doctors of each over-70s patient will be €550-€600.
This compares with the headline rate of €308.77 for over-70s medical card patients announced by the arbitrator, Eddie Sullivan, late last month. GPs will continue to be paid €974 per annum for nursing home residents aged over 70.
In the original Budget proposal, Minister for Health Mary Harney ended the automatic entitlement of all over-70s to a medical card. Following a major public outcry, the Government announced it would engage with the IMO to review the decision with a view to identifying alternative ways of saving €100 million from the medical card scheme.
The Government subsequently announced a new income threshold that would allow 95 per cent of over-70s to retain a full medical card. And it asked Eddie Sullivan, chairman of the Public Appointments Service, to recommend a new capitation rate to be paid to doctors for these patients.
The Government also announced the setting up of an expert group, under the chairmanship of Dr Michael Barry, director of the National Centre for Pharmacoeconomics, "to develop recommendations for good medical practice which will secure safe and effective prescribing for patients while maximising the potential for economy in the use of public funds".
The IMO had indicated to Government that savings of €80 million per annum could be achieved by a drugs savings initiative. The IMO letter claims that GPs will lose €16 million in capitation payments following the fee changes but it estimated that the medical card scheme, including all fees and allowances, would be worth in the region of €550 million to doctors in 2009.
While the letter carefully avoids giving direct advice to members, the lack of a specific reference to a ballot by the organisation raises the possibility the new fee structure will be unilaterally introduced on January 1st next.