S.I. No. 233/2016 - Health Professionals (Variations of Payments to General Practitioners) Regulations 2016.

Notice of the making of this Statutory Instrument was published in

“Iris Oifigiúil” of 13th May, 2016.

The Minister for Health, in exercise of the powers conferred on him by section 9 (amended by section 8 of the Financial Emergency Measures in the Public Interest Act 2015 (No. 39 of 2015)), of the Financial Emergency Measures in the Public Interest Act 2009 (No. 5 of 2009), (as adapted by the Health and Children (Alteration of Name of Department and Title of Minister) Order 2011 ( S.I. No. 219 of 2011 )), having complied with subsections (4), (7) and (13) of that section, with the consent of the Minister for Public Expenditure and Reform, hereby makes the following regulations:

1. These Regulations may be cited as the Health Professionals (Variations of Payments to General Practitioners) Regulations 2016.

2. In these Regulations—

“Capitation 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 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 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;

“GMS panel” means the total number of patients of a general practitioner to whom the general practitioner provides services under the General Medical Services Scheme;

“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;

“practice unit” means—

(a) a practice comprised of a single general practitioner or a partnership of more than one general practitioner, or

(b) a group practice of more than one general practitioner providing general practitioner services from the same centre of practice;

“qualifying area” means an area which has a population of less than or equal to 2,000 within a 4.8 kilometre radius of the principal practice address of a practice unit;

“Regulations of 2013” means the Health Professionals (Reduction of Payments to General Practitioners) Regulations 2013 ( S.I. No. 277 of 2013 ).

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 , the Maternity and Infant Care Scheme and the Heartwatch Programme.

4. Subject to Regulation 5, the amounts of 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 Schedules 1 to 18.

5. In determining the size of a general practitioner’s GMS panel for the purposes of calculating the amount of an allowance referred to in Schedule 8 that is payable (if any) to the general practitioner in respect of practice support, every patient on that general practitioner’s GMS panel who is 70 years or over shall count as 2 patients.

6. The Regulations of 2013 are revoked.

SCHEDULE 1

Services rendered under the General Medical Services Scheme — Capitation Agreement—general practitioner capitation rates (all amounts inclusive of former payments towardspractice maintenance, equipment and development and former payments in respect ofdiscretionary medical cards)
Reference Number	Description	Amount
(1)	(2)	(3)
1.	Male patient aged under 5 years	€74.59
2.	Male patient aged 5 years or more and less than 16 years	€43.29
3.	Male patient aged 16 years or more and less than 45 years	€55.26
4.	Male patient aged 45 years or more and less than 65 years	€110.38
5.	Male patient aged 65 years or more and less than 70 years	€116.28
6.	Patient aged 70 years or more residing in the community	€271.62
7.	Patient aged 70 years or more residing in a private nursing home (approved by the HSE) for continuous periods in excess of 5 weeks	€434.15
8.	Female patient aged under 5 years	€72.76
9.	Female patient aged 5 years or more and less than 16 years	€43.79
10.	Female patient aged 16 years or more and less than 45 years	€90.37
11.	Female patient aged 45 years or more and less than 65 years	€121.29
12.	Female patient aged 65 years or more and less than 70 years	€129.72
13.	Supplementary out-of-hours fee	€3.64

SCHEDULE 2

Services rendered under the General Medical Services Scheme — Capitation Agreement—out-of-hours payments (in respect of consultations other than day consultations orconsultations occurring as part of an overflow in respect of normal surgery hours) (allamounts inclusive of the former additional allowance for the provision of rostering and outof-hours arrangements)
Reference Number	Description	Amount
(1)	(2)	(3)
1.	Surgery consultation Monday to Friday (excluding public holidays) between the hours of 5 p.m. and 6 p.m. on the same day and 8 a.m. and 9 a.m. on the same day	€13.88
2.	Surgery consultation Monday to Friday between the hours of 6 p.m. and 8 a.m. the following day and any time on Saturday, Sunday and public holidays	€41.63
3.	Domiciliary visit out-of-hours	€41.63
4.	Surgery consultation or domiciliary visit out-of-hours where a general practitioner sees an additional patient under the General Medical Services Scheme during the same consultation or visit	€13.88

SCHEDULE 3

Services rendered under the General Medical Services Scheme — Capitation Agreement andFee Per Item Agreement — payments to a general practitioner in respect of temporaryresidents, EEA visitors and emergency consultations where a general practitioner seesanother general practitioner’s patient under the General Medical Services Scheme in anemergency
Reference Number	Description	Amount
(1)	(2)	(3)
1.	Surgery consultation	€40.94
2.	Domiciliary visit	€40.94

SCHEDULE 4

Services rendered under the General Medical Services Scheme — Capitation Agreement—payments to a general practitioner in respect of special items of service
Reference Number	Description	Amount
(1)	(2)	(3)
1.	Excisions/cryotherapy/diathermy of skin lesions	€24.80
2.	Suturing of cuts and lacerations — including application of tissue glue (does not include paper sutures)	€50.00
3.	Draining of hydroceles	€24.80
4.	Treatment and plugging of dental and nasal haemorrhages	€24.80
5.	Cardiovascular investigations, solely for cases of individual patient care and not general screening or routine screening of individuals or both:(a) Electrocardiography (ECG) tests and interpretation;(b) 24 Hour Ambulatory Blood Pressure Monitoring for diagnosis and treatment of hypertension	€24.80 €60.00
6.	Removal of adherent foreign bodies from the conjunctival surface of the eye	€24.80
7.	Removal of lodged or impacted foreign bodies from the ear, nose and throat	€24.80
8.	Nebuliser treatment in the case of acute asthmatic attack	€37.21
9.	Bladder catheterization — composite fee for insertion and removal	€60.00
10.	Long Acting Reversible Contraceptive Device (LARC) for counselling, insertion and monitoring and GP possesses current LARC Certification (ICGP) or equivalent)	€70.00
11.	Removal of a Long Acting Reversible Contraceptive Device (LARC)	€50.00
12.	Attendance by general practitioner at HSE-convened case conference	€62.02

SCHEDULE 5

Services rendered under the General Medical Services Scheme — Capitation Agreement—allowance in respect of a general practitioner or general practice unit
Reference Number	Description	Amount
(1)	(2)	(3)
1.	Rural practice allowance per annum per general practitioner: (a) where— (i) a general practitioner was in receipt of the rural practice allowance under Schedule 5 of the Regulations of 2013 immediately before the date of these Regulations, and (ii) that general practitioner is not eligible for the rural practice support framework allowance referred to at reference number 2 of this Schedule; or (b) where— (i) a general practitioner was in receipt of the rural practice allowance under Schedule 5 of the Regulations of 2013 immediately before the date of these Regulations, (ii) that general practitioner is eligible for the rural practice support framework allowance referred to at reference number 2 of this Schedule, and (iii) after the date of these Regulations, that general practitioner— (I) ceases to be eligible for the rural practice support framework allowance referred to at reference number 2 of this Schedule, and (II) continues to provide general practitioner services in the same qualifying area for which he or she received that allowance.	€16,216.07
2.	Rural practice support framework allowance per annum per practice unit: (a) where— (i) after the date of these Regulations, the practice unit is eligible for, and elects to receive, the rural practice support framework allowance under these Regulations, and (ii) there is no other practice unit in the same qualifying area on the date of these Regulations; or (b) where— (i) immediately before the date of these Regulations, a general practitioner in a practice unit was in receipt of the allowance under Schedule 5 of the Regulations of 2013, (ii) on the date of these Regulations, that practice unit is eligible for, and elects to receive, the rural practice support framework allowance under this Schedule, and (iii) there is one other practice unit in the same qualifying area.	€20,000.00
3.	Modified rural practice support framework allowance per annum, per practice unit: (a) where— (i) 2 practice units were, on the date of these Regulations, providing general practitioner services in the same qualifying area, and (ii) both of those practice units were not in receipt of the rural practice allowance under Schedule 5 of the Regulations of 2013 immediately before the date of these Regulations, or (b) where— (i) 2 practice units were, on the date of these Regulations, providing general practitioner services in the same qualifying area, and (ii) one of such 2 practice units was not in receipt of the rural practice allowance under Schedule 5 of the Regulations of 2013 immediately before the date of these Regulations, the modified rural practice support framework allowance is payable to the practice unit which was not in receipt of that rural practice allowance.	€10,000.00

SCHEDULE 6

Services rendered under the General Medical Services Scheme — Capitation Agreement—fees payable to a general practitioner (GP) for dispensing in accordance with Circular titled“Certain Matters Relating to the Provision of Services Under Section 58 of the Health Act1970” dated 24 September 1999
Reference Number	Description	Amount
(1)	(2)	(3)
1.	Opt-in GP (dispensing doctor)	€38.03
2.	Pilot GP (dispensing doctor)	€43.88
3.	Continuous GP (dispensing doctor)	€12.48

SCHEDULE 7

Services rendered under the General Medical Services Scheme — Capitation Agreement—payment to a general practitioner for a second medical opinion
Description	Amount
(1)	(2)
Fee for second medical opinion	€26.46

SCHEDULE 8

Services rendered under the General Medical Services Scheme — Capitation Agreement—maximum allowances in respect of practice support payable on the basis of a general practitioner’s GMS panel size as determined in accordance with Regulation 5 (all amounts inclusive of the former supplementary grant to general practitioners who employed secretaries or nurses or both)
Reference Number	Description	Amount
(1)	(2)	(3)
1.	Nursing subsidy (per year) — 1 year’s experience	€30,945.86
2.	Nursing subsidy (per year) — 2 years’ experience	€32,665.07
3.	Nursing subsidy (per year) — 3 years’ experience	€34,384.29
4.	Nursing subsidy (per year) — 4 or more years’ experience	€37,822.72
5.	Secretarial subsidy (per year) — 1 year’s experience	€20,630.57
6.	Secretarial subsidy (per year) — 2 years’ experience	€22,349.80
7.	Secretarial subsidy (per year) — 3 or more years’ experience	€24,068.99
8.	Practice manager subsidy (per year) — based on first point of nursing subsidy	€30,945.86

SCHEDULE 9

Services rendered under the General Medical Services Scheme — Capitation Agreement—maximum allowances payable to a general practitioner in respect of locum expenses
Reference Number	Description	Amount
(1)	(2)	(3)
1.	Annual leave (per day)	€197.24
2.	Annual leave (per week)	€1,380.65
3.	Sick leave (per day) during the first week	€197.24
4.	Sick leave (per week) for the first week	€986.18
5.	Sick leave (per day) from week 2 to week 26	€197.24
6.	Sick leave (per week) from week 2 to week 26	€1,380.65
7.	Sick leave (per day) from week 27 to week 52	€98.62
8.	Sick leave (per week) from week 27 to week 52	€690.33
9.	Study leave (per day)	€197.24
10.	Study leave (per week)	€1,380.65
11.	Maternity leave (per day)	€197.24
12.	Maternity leave (per week)	€1,380.65
13.	Paternity leave (per day)	€197.24
14.	Adoptive leave (per day)	€197.24
15.	Adoptive leave (per week)	€1,380.65
16.	Annual leave — former District Medical Officer:
	(a) maximum rate — payable for each of the first 3 days annual leave in a year	€66.47
	(b) medium rate — payable for each of the next 25 days annual leave in that year	€56.86
	(c) minimum rate — payable for each other annual leave day in that year	€48.92
17.	Statutory leave — meetings of statutory bodies (per day)	€197.24
18.	Attendance at Irish Medical Organisation general practitioner meetings (per day)	€197.24

SCHEDULE 10

Services rendered under the General Medical Services Scheme — Capitation Agreement—payment to a general practitioner in respect of the registration of asylum seekers
Description	Amount
(1)	(2)
Asylum seeker/non EU registration fee (a once-off superannuable registration fee)	€173.69

SCHEDULE 11

Services rendered under the General Medical Services Scheme — Fee Per Item Agreement— general practitioner consultation fees
Reference Number	Description	Amount
(1)	(2)	(3)
1.	Surgery — day consultation with patient	€11.87
2.	Surgery — late consultation with patient	€16.88
3.	Surgery — night consultation with patient	€33.38
4.	Domiciliary visit — day consultation with patient	€17.51
5.	Domiciliary visit — late consultation with patient	€22.93
6.	Domiciliary visit — night consultation with patient	€44.96

SCHEDULE 12

Services rendered under the General Medical Services Scheme — Fee Per Item Agreement— payment for a consultation by a general practitioner at a home for the aged
Description	Amount
(1)	(2)
Consultation at home for the aged per 3 hour session	€73.18

SCHEDULE 13

Services rendered under the General Medical Services Scheme — Fee Per Item Agreement— allowance in respect of a general practitioner whose practice is eligible for a rural practice allowance
Description	Amount
(1)	(2)
Rural practice allowance (per annum)	€7,042.91

SCHEDULE 14

Services rendered under the General Medical Services Scheme — Fee Per Item Agreement— allowance in respect of locum and practice expenses
Description	Amount
(1)	(2)
Allowance in respect of locum and practice expenses (per annum)	€1,371.06

SCHEDULE 15

Services rendered under the General Medical Services Scheme — Fee Per Item Agreement— payments to a general practitioner in respect of special items of service
Reference Number	Description	Amount
(1)	(2)	(3)
1.	Excisions/ cryotherapy/ diathermy of skin lesions	€22.43
2.	Suturing of cuts & lacerations	€22.43
3.	Draining of hydroceles	€22.43
4.	Treatment and plugging of dental and nasal haemorrhages	€22.43
5.	Recognised vein treatment	€22.43
6.	Electrocardiography (ECG) tests & their interpretation	€22.43
7.	Instruction in the fitting of a diaphragm	€22.43

SCHEDULE 16

Services rendered under the Health (Amendment) Act 1996
Reference Number	Description	Amount
(1)	(2)	(3)
1.	Surgery consultation	€30.53
2.	Domiciliary visit	€40.27

SCHEDULE 17

Services rendered under the Maternity and Infant Care Scheme
Reference Number	Description	Amount
(1)	(2)	(3)
1.	Patient’s first visit	€38.42
2.	Visits 2-8 (per visit)	€27.67
3.	Visit 9	€38.42
4.	Where complete services are provided — patient’s first pregnancy	€242.85
5.	Where complete services are provided — pregnancies other than the patient’s first pregnancy	€270.52
6.	Additional visits by patients with major conditions, e.g. diabetes, hypertension — fee per visit subject to maximum of 5 visits	€27.67
7.	Emergency delivery	€230.53

SCHEDULE 18

Payments to a general practitioner under the Heartwatch Programme
Reference Number	Description	Amount
(1)	(2)	(3)
1.	Once-off registration fee payable where a general practitioner registers 15 or more patients in the Heartwatch Programme	€982.81
2.	Amount payable to a general practitioner for each visit by a patient registered under the Heartwatch Programme up to a maximum of 4 visits by the patient concerned in a year	€39.31
3.	Bonus amount payable to a general practitioner where a patient registered under the Heartwatch Programme makes a fourth visit to the general practitioner under that Programme in a year	€39.31

The Minister for Public Expenditure and Reform consents to the foregoing Regulations.

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GIVEN under the Official Seal of the Minister for Public Expenditure and Reform,

5 May 2016.

BRENDAN HOWLIN,

Minister for Public Expenditure and Reform.

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GIVEN under my Official Seal of the Minister for Health,

5 May 2016.

LEO VARADKAR,

Minister for Health.

EXPLANATORY NOTE

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

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 , the Maternity and Infant Care Scheme and the Heartwatch Programme.