S.I. No. 262/2009 - Health Professionals (Reduction of Payments To General Practitioners) Regulations 2009


S.I. No. 262 of 2009

HEALTH PROFESSIONALS (REDUCTION OF PAYMENTS TO GENERAL PRACTITIONERS) REGULATIONS 2009

Notice of the making of this Statutory Instrument was published in

“Iris Oifigiúil” of 14th July, 2009.

I, MARY HARNEY, Minister for Health and Children, in exercise of the powers conferred on me by section 9 of the Financial Emergency Measures in the Public Interest Act 2009 (No. 5 of 2009), having complied with subsections (4) and (7) of that section, with the consent of the Minister for Finance, hereby make the following regulations:

1. These Regulations may be cited as the Health Professionals (Reduction of Payments to General Practitioners) Regulations 2009.

2. In these Regulations—

“Capitation Agreement” means an agreement between the Health Service Executive (HSE) and a general practitioner made in accordance with the conditions specified by the Minister for Health and Children in 1989 regarding the provision of services to eligible persons under section 58 of the Health Act 1970 (No. 1 of 1970) by general practitioners, as amended from time to time;

“day consultation” means a consultation during normal hours of a general practitioners surgery as agreed between the Health Service Executive and that general practitioner;

“Fee Per Item Agreement” means an agreement between the Health Service Executive and a general practitioner made in accordance with the conditions specified by the Minister for Health and Children in 1972 regarding the provision of services to eligible persons under section 58 of the Health Act 1970 (No. 1 of 1970) by general practitioners, as amended from time to time;

“late consultation” means a consultation other than a day consultation or a night consultation;

“night consultation” means a consultation during the period between midnight and 8 a.m. the following day.

3. These Regulations shall apply to payments in respect of services rendered by a general practitioner to or on behalf of the Health Service Executive under the General Medical Services Scheme, the Health (Amendment) Act 1996 and the Maternity and Infant Care Scheme.

4. The payments that shall be made to a general practitioner in respect of the services referred to in Regulation 3 from the date of the making of these Regulations shall be those specified in Tables 1 to 18 below.

TABLE 1

Services rendered under the General Medical Services (GMS) Scheme — Capitation Agreement — general practitioner capitation rates

Service

Amount

Male patient aged under 5 years living 3 miles or less from the surgery

76.98

Male patient aged under 5 years living more than 3 miles but not more than 5 miles from the surgery

81.07

Male patient aged under 5 years living more than 5 miles but not more than 7 miles from the surgery

87.11

Male patient aged under 5 years living more than 7 miles but not more than 10 miles from the surgery

93.09

Male patient aged under 5 years living more than 10 miles from the surgery

100.48

Male patient aged 5 years or more and less than 16 years living 3 miles or less from the surgery

44.68

Male patient aged 5 years or more and less than 16 years living more than 3 miles but not more than 5 miles from the surgery

46.38

Male patient aged 5 years or more and less than 16 years living more than 5 miles but not more than 7 miles from the surgery

48.87

Male patient aged 5 years or more and less than 16 years living more than 7 miles but not more than 10 miles from the surgery

51.29

Male patient aged 5 years or more and less than 16 years living more than 10 miles from the surgery

54.33

Male patient aged 16 years or more and less than 45 years living 3 miles or less from the surgery

57.03

Male patient aged 16 years or more and less than 45 years living more than 3 miles but not more than 5 miles from the surgery

59.23

Male patient aged 16 years or more and less than 45 years living more than 5 miles but not more than 7 miles from the surgery

62.49

Male patient aged 16 years or more and less than 45 years living more than 7 miles but not more than 10 miles from the surgery

65.68

Male patient aged 16 years or more and less than 45 years living more than 10 miles from the surgery

69.60

Male patient aged 45 years or more and less than 65 years living 3 miles or less from the surgery

113.91

Male patient aged 45 years or more and less than 65 years living more than 3 miles but not more than 5 miles from the surgery

119.19

Male patient aged 45 years or more and less than 65 years living more than 5 miles but not more than 7 miles from the surgery

126.98

Male patient aged 45 years or more and less than 65 years living more than 7 miles but not more than 10 miles from the surgery

134.65

Male patient aged 45 years or more and less than 65 years living more than 10 miles from the surgery

144.22

Male patient aged 65 years or more and less than 70 years living 3 miles or less from the surgery

120.00

Male patient aged 65 years or more and less than 70 years living more than 3 miles but not more than 5 miles from the surgery

134.67

Male patient aged 65 years or more and less than 70 years living more than 5 miles but not more than 7 miles from the surgery

156.46

Male patient aged 65 years or more and less than 70 years living more than 7 miles but not more than 10 miles from the surgery

177.85

Male patient aged 65 years or more and less than 70 years living more than 10 miles from the surgery

204.46

Patient aged 70 years or more

280.31

Patient aged 70 years or more, residing in a private nursing home (approved by the HSE) for continuous periods in excess of 5 weeks

896.07

Female patient aged under 5 years living 3 miles or less from the surgery

75.09

Female patient aged under 5 years living more than 3 miles but not more than 5 miles from the surgery

79.19

Female patient aged under 5 years living more than 5 miles but not more than 7 miles from the surgery

85.27

Female patient aged under 5 years living more than 7 miles but not more than 10 miles from the surgery

91.25

Female patient aged under 5 years living more than 10 miles from the surgery

98.63

Female patient aged 5 years or more and less than 16 years living 3 miles or less from the surgery

45.19

Female patient aged 5 years or more and less than 16 years living more than 3 miles but not more than 5 miles from the surgery

46.88

Female patient aged 5 years or more and less than 16 years living more than 5 miles but not more than 7 miles from the surgery

49.43

Female patient aged 5 years or more and less than 16 years living more than 7 miles but not more than 10 miles from the surgery

51.81

Female patient aged 5 years or more and less than 16 years living more than 10 miles from the surgery

54.80

Female patient aged 16 years or more and less than 45 years living 3 miles or less from the surgery

93.26

Female patient aged 16 years or more and less than 45 years living more than 3 miles but not more than 5 miles from the surgery

95.46

Female patient aged 16 years or more and less than 45 years living more than 5 miles but not more than 7 miles from the surgery

98.70

Female patient aged 16 years or more and less than 45 years living more than 7 miles but not more than 10 miles from the surgery

101.37

Female patient aged 16 years or more and less than 45 years living more than 10 miles from the surgery

105.81

Female patient aged 45 years or more and less than 65 years living 3 miles or less from the surgery

125.17

Female patient aged 45 years or more and less than 65 years living more than 3 miles but not more than 5 miles from the surgery

130.45

Female patient aged 45 years or more and less than 65 years living more than 5 miles but not more than 7 miles from the surgery

138.21

Female patient aged 45 years or more and less than 65 years living more than 7 miles but not more than 10 miles from the surgery

145.93

Female patient aged 45 years or more and less than 65 years living more than 10 miles from the surgery

155.43

Female patient aged 65 years or more and less than 70 years living 3 miles or less from the surgery

133.87

Female patient aged 65 years or more and less than 70 years living more than 3 miles but not more than 5 miles from the surgery

148.56

Female patient aged 65 years or more and less than 70 years living more than 5 miles but not more than 7 miles from the surgery

170.34

Female patient aged 65 years or more and less than 70 years living more than 7 miles but not more than 10 miles from the surgery

191.75

Female patient aged 65 years or more and less than 70 years living more than 10 miles from the surgery

218.37

Supplementary out-of-hours fee

3.76

TABLE 2

Services rendered under the General Medical Services (GMS) Scheme — Capitation Agreement — out-of-hours payments (in respect of consultations other than day consultations or consultations occurring as part of an overflow in respect of normal surgery hours)

Service

Amount

Surgery consultation — out-of-hours payment

46.59

Domiciliary visit — out-of-hours payment where the patient lives 3 miles or less from the surgery

46.59

Domiciliary visit — out-of-hours payment where the patient lives more than 3 miles but not more than 5 miles from the surgery

62.17

Domiciliary visit — out-of-hours payment where the patient lives more than 5 miles but not more than 7 miles from the surgery

69.98

Domiciliary visit — out-of-hours payment where the patient lives more than 7 miles but not more than 10 miles from the surgery

77.68

Domiciliary visit — out-of-hours payment where the patient lives more than 10 miles from the surgery

93.24

Domiciliary visit — out-of-hours payment where a consultation involving an additional GMS patient occurs during the same domiciliary visit

36.37

TABLE 3

Services rendered under the General Medical Services (GMS) Scheme — payments to a general practitioner (GP) in respect of temporary residents, EEA visitors and emergency consultations where a GP sees another GP's GMS patient in an emergency

Service

Amount

Surgery — day consultation

46.59

Surgery — late consultation

46.59

Surgery — night consultation

46.59

Domiciliary visit — day consultation with patient living 3 miles or less from the surgery

46.59

Domiciliary visit — day consultation with patient living more than 3 miles but not more than 5 miles from the surgery

62.17

Domiciliary visit — day consultation with patient living more than 5 miles but not more than 7 miles from the surgery

69.98

Domiciliary visit — day consultation with patient living more than 7 miles but not more than 10 miles from the surgery

77.68

Domiciliary visit — day consultation with patient living more than 10 miles from the surgery

93.24

Domiciliary visit — late consultation with patient living 3 miles or less from the surgery

46.59

Domiciliary visit — late consultation with patient living more than 3 miles but not more than 5 miles from the surgery

62.17

Domiciliary visit — late consultation with patient living more than 5 miles but not more than 7 miles from the surgery

69.98

Domiciliary visit — late consultation with patient living more than 7 miles but not more than 10 miles from the surgery

77.68

Domiciliary visit — late consultation with patient living more than 10 miles from the surgery

93.24

Domiciliary visit — night consultation with patient living 3 miles or less from the surgery

46.59

Domiciliary visit — night consultation with patient living more than 3 miles but not more than 5 miles from the surgery

62.17

Domiciliary visit — night consultation with patient living more than 5 miles but not more than 7 miles from the surgery

69.98

Domiciliary visit — night consultation with patient living more than 7 miles but not more than 10 miles from the surgery

77.68

Domiciliary visit — night consultation with patient living more than 10 miles from the surgery

93.24

TABLE 4

Services rendered under the General Medical Services (GMS) Scheme — Capitation Agreement — payments to a general practitioner (GP) in respect of special items of service

Service

Amount

Excisions/cryotherapy/diathermy of skin lesions

29.14

Suturing of cuts and lacerations

29.14

Draining of hydroceles

29.14

Treatment and plugging of dental and nasal haemorrhages

29.14

Recognised vein treatment

29.14

Electrocardiography (ECG) tests and their interpretation

29.14

Instruction in the fitting of a diaphragm

29.14

Removal of adherent foreign bodies from the conjunctival surface of the eye

29.14

Removal of lodged or impacted foreign bodies from the ear, nose and throat

29.14

Nebuliser treatment in the case of acute asthmatic attack

43.73

Bladder catheterization

43.73

Advice and fitting of a diaphragm

49.05

Counselling and fitting of an intra uterine contraceptive device (IUCD)

78.49

Attendance by GP at HSE-convened case conference

72.88

TABLE 5

Services rendered under the General Medical Services (GMS) Scheme — Capitation Agreement — allowance in respect of a general practitioner whose practice is eligible for a rural practice allowance

Service

Amount

Rural practice allowance (per annum)

19,055.31

TABLE 6

Services rendered under the General Medical Services (GMS) Scheme — Capitation Agreement — fees payable to a general practitioner (GP) for dispensing in accordance with the circular titled "Certain matters relating to the provision of services under section 58 of the Health Act 1970 " dated 24 September 1999

Service

Amount

Opt-in GP (dispensing doctor)

44.69

Pilot GP (dispensing doctor)

51.56

Continuous GP (dispensing doctor)

14.66

TABLE 7

Services rendered under the General Medical Services (GMS) Scheme — Capitation Agreement — payment to a general practitioner for a second medical opinion

Service

Amount

Fee for second medical opinion

31.09

TABLE 8

Services rendered under the General Medical Services (GMS) Scheme — Capitation Agreement — maximum allowances in respect of practice support payable on the basis of a general practitioner's GMS panel size

Service

Amount

Nursing subsidy (per year) — 1 years experience

32,903.63

Nursing subsidy (per year) — 2 years experience

34,731.60

Nursing subsidy (per year) — 3 years experience

36,559.59

Nursing subsidy (per year) — 4 or more years experience

40,215.55

Secretarial subsidy (per year) — 1 years experience

21,935.75

Secretarial subsidy (per year) — 2 years experience

23,763.74

Secretarial subsidy (per year) — 3 or more years experience

25,591.70

Practice manager subsidy (per year) — based on first point of nursing subsidy

32,903.63

TABLE 9

Services rendered under the General Medical Services (GMS) Scheme — Capitation Agreement — maximum allowances payable to a general practitioner (GP) in respect of locum expenses

Service

Amount

Annual leave (per day)

231.77

Annual leave (per week)

1,622.39

Sick leave (per day) during the first week

231.77

Sick leave (per week) for the first week

1,158.85

Sick leave (per day) from week 2 to week 26

231.77

Sick leave (per week) from week 2 to week 26

1,622.39

Sick leave (per day) from week 27 to week 52

115.89

Sick leave (per week) from week 27 to week 52

811.20

Study leave (per day)

231.77

Study leave (per week)

1,622.39

Maternity leave (per day)

231.77

Maternity leave (per week)

1,622.39

Paternity leave (per day)

231.77

Adoptive leave (per day)

231.77

Adoptive leave (per week)

1,622.39

Annual leave — former District Medical Officer:(a) maximum rate — payable for each of the first 3 days annual leave in a year(b) medium rate — payable for each of the next 25 days annual leave in that year(c) minimum rate — payable for each other annual leave day in that year

78.1166.8157.48

Statutory leave — meetings of statutory bodies (per day)

231.77

Attendance at Irish Medical Organisation GP meetings (per day)

231.77

TABLE 10

Services rendered under the General Medical Services (GMS) Scheme — Capitation Agreement — payment to a general practitioner in respect of the registration of asylum seekers

Service

Amount

Asylum seeker/non EU registration fee (a once-off superannuable registration fee)

179.25

TABLE 11

Services rendered under the General Medical Services (GMS) Scheme — Fee Per Item Agreement — general practitioner consultation fees

Service

Amount

Surgery — day consultation with patient

12.83

Surgery — late consultation with patient

18.25

Surgery — night consultation with patient

36.09

Domiciliary visit — day consultation with patient (urban)

18.93

Domiciliary visit — day consultation with patient living 3 miles or less from the surgery

18.93

Domiciliary visit — day consultation with patient living more than 3 miles but not more than 5 miles from the surgery

24.79

Domiciliary visit — day consultation with patient living more than 5 miles but not more than 7 miles from the surgery

33.30

Domiciliary visit — day consultation with patient living more than 7 miles but not more than 10 miles from the surgery

41.76

Domiciliary visit — day consultation with patient living more than 10 miles from the surgery

52.22

Domiciliary visit — late consultation (urban)

24.79

Domiciliary visit — late consultation with patient living 3 miles or less from the surgery

24.79

Domiciliary visit — late consultation with patient living more than 3 miles but not more than 5 miles from the surgery

32.08

Domiciliary visit — late consultation with patient living more than 5 miles but not more than 7 miles from the surgery

41.76

Domiciliary visit — late consultation with patient living more than 7 miles but not more than 10 miles from the surgery

55.48

Domiciliary visit — late consultation with patient living more than 10 miles from the surgery

65.05

Domiciliary visit — night consultation (urban)

48.61

Domiciliary visit — night consultation with patient living 3 miles or less from the surgery

48.61

Domiciliary visit — night consultation with patient living more than 3 miles but not more than 5 miles from the surgery

62.49

Domiciliary visit — night consultation with patient living more than 5 miles but not more than 7 miles from the surgery

79.05

Domiciliary visit — night consultation with patient living more than 7 miles but not more than 10 miles from the surgery

88.20

Domiciliary visit — night consultation with patient living more than 10 miles from the surgery

95.75

TABLE 12

Services rendered under the General Medical Services (GMS) Scheme — Fee Per Item Agreement — payment for a consultation by a general practitioner at a home for the aged

Service

Amount

Sessional rates (per 3 hour session) — consultation at a home for the aged

85.99

TABLE 13

Services rendered under the General Medical Services (GMS) Scheme — Fee Per Item Agreement — allowance in respect of a general practitioner whose practice is eligible for a rural practice allowance

Service

Amount

Rural practice allowance (per annum)

8,276.04

TABLE 14

Services rendered under the General Medical Services (GMS) Scheme — Fee Per Item Agreement — allowance in respect of locum and practice expenses

Service

Amount

Allowance in respect of locum and practice expenses (per annum)

1,611.12

TABLE 15

Services rendered under the General Medical Services (GMS) Scheme — Fee Per Item Agreement — payments to a general practitioner in respect of special items of service

Service

Amount

Excisions/cryotherapy/diathermy of skin lesions

26.36

Suturing of cuts & lacerations

26.36

Draining of hydroceles

26.36

Treatment and plugging of dental and nasal haemorrhages

26.36

Recognised vein treatment

26.36

Electrocardiography (ECG) tests & their interpretation

26.36

Instruction in the fitting of a diaphragm

26.36

TABLE 16

Services rendered under the General Medical Services (GMS) Scheme — payment to a general practitioner (GP) pursuant to the agreement titled “Agreement with registered medical practitioners for provision of services to certain persons with limited eligibility under section 58 of the Health Act 1970 as substituted by the Health (Amendment) Act, 2005”

Service

Amount

GP visit card registration fee in respect of each first-time qualified person for a GP visit card registered to the GP subject to the agreed overall limit on the aggregate of all such payments

32.20

TABLE 17

Services rendered under the Health (Amendment) Act 1996

Service

Amount

Surgery — consultation fee

35.87

Domiciliary visit — consultation fee

47.31

TABLE 18

Services rendered under the Maternity and Infant Care Scheme

Service

Amount

Patients first visit

45.14

Visits 2-8 (per visit)

32.51

Visit 9

45.14

Where complete services are provided — patients first pregnancy

285.37

Where complete services are provided — pregnancies other than the patients first pregnancy

317.88

Additional visits by patients with major conditions, e.g. diabetes, hypertension — fee per visit subject to a maximum of 5 visits

32.51

Emergency delivery

270.89

The Minister for Finance consents to the foregoing Regulations.

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GIVEN under my Official Seal,

7 July 2009

BRIAN LENIHAN.

Minister for Finance.

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GIVEN under my Official Seal,

7 July 2009

MARY HARNEY.

Minister for Health and Children.

EXPLANATORY NOTE

(This note is not part of the Instrument and does not purport to be a legal interpretation)

These Regulations provide for a reduction of payments to general practitioners in respect of services under the General Medical Services Scheme, the Maternity and Infant Care Scheme and the Health (Amendment) Act 1996 .