Public Service Pay and Pensions Act 2017 (Section 42) (Payments to General Practitioners) Regulations 2019

• Jurisdiction: Ireland
• Citation: IR SI 692/2019
• Year: 2019

Notice of the making of this Statutory Instrument was published in

“Iris Oifigiúil” of 7th January, 2020.

I, SIMON HARRIS, Minister for Health, in exercise of the powers conferred on me by section 42 of the Public Service Pay and Pensions Act 2017 (No. 34 of 2017), being satisfied that subsection (6) of that section has been complied with; having complied with subsection (9) of that section; having had regard to the matters specified in paragraphs (a) to (e) of subsection (10) of that section, with the consent of the Minister for Public Expenditure and Reform, hereby make the following regulations:

1. These Regulations may be cited as the Public Service Pay and Pensions Act 2017 (Section 42) (Payments to General Practitioners) Regulations 2019.

2. These Regulations shall come into operation on 1 January 2020.

3. In these Regulations -

“6 in 1 vaccine” means a vaccine against Diphtheria, Tetanus, Pertussis, Haemophilus influenzae type b, Poliomyelitis and Hepatitis B;

“4 in 1 vaccine” means a booster vaccine against Diphtheria, Tetanus, Pertussis and Poliomyelitis;

“Act of 1970” means the Health Act 1970 (No. 1 of 1970);

“Agreement of 2019” means the agreement dated 23 May 2019 between the Minister, the Health Service Executive and the Irish Medical Organisation known as the General Practitioner Contractual Reform and Service Development Agreement;

“Capitation Agreement” means an agreement between the Health Service Executive and a general practitioner made in accordance with the conditions specified by the Minister in 1989 regarding the provision of services to eligible persons under section 58 of the Act of 1970 by general practitioners, as amended from time to time;

“combined Hib/Men C vaccine” means a vaccine against Haemophilus influenzae type b and Meningococcal group C bacteria;

“day consultation” means a consultation during normal hours of a general practitioner’s 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 in 1972 regarding the provision of services to eligible persons under section 58 of the Act of 1970 by general practitioners, as amended from time to time;

“General Medical Services Scheme” has the meaning assigned to it by section 1 of the Health (Provision of General Practitioner Services) Act 2012 (No. 4 of 2012);

“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;

“influenza vaccine” means a vaccine against seasonal influenza;

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

“Men B vaccine” means a vaccine against Meningococcal group B bacteria;

“Men C vaccine” means a vaccine against Meningococcal group C bacteria;

“Minister” means the Minister for Health;

“MMR vaccine” means a vaccine against Measles, Mumps and Rubella;

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

“PCV” means the Pneumococcal Conjugate Vaccine;

“PPV” means the Pneumococcal Polysaccharide Vaccine;

“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;

“registered child”, in relation to a service provider, means a child to whom that service provider has been assigned for the purposes of the administration of vaccines under the Primary Childhood Immunisation Programme;

“Regulations of 2016” means the Health Professionals (Variation of Payments to General Practitioners) Regulations 2016 ( S.I. No. 233 of 2016 );

“Rotavirus vaccine” means a vaccine against Rotavirus disease;

“service” means a service specified in Schedules 1 to 34 rendered by a service provider under and in accordance with the terms of the General Medical Services Scheme, the Health (Amendment) Act 1996 (No. 15 of 1996), the Mental Health Act 2001 (No. 25 of 2001), the National Cervical Screening Programme, the Primary Childhood Immunisation Programme and the National Immunisation Programmes;

“service provider” means a general practitioner who renders a service to or on behalf of the Health Service Executive under and in accordance with the terms of the General Medical Services Scheme, the Health (Amendment) Act 1996 , the Mental Health Act 2001 , the National Cervical Screening Programme, the Primary Childhood Immunisation Programme and the National Immunisation Programmes;

“set of vaccines”, in relation to a particular age or particular ages referred to under the Primary Childhood Immunisation Programme, means the specific vaccine or vaccines which are scheduled to be administered to a child at that age or those ages, as the case may be;

“under 6 contract” means an agreement between the Health Service Executive and a general practitioner made in accordance with the conditions specified by the Minister in section 58C of the Act of 1970 regarding the provision of services to eligible persons under section 58B of that Act by the general practitioner.

4. These Regulations shall apply to payments in respect of services rendered by a service provider to or on behalf of the Health Service Executive under and in accordance with the terms of the General Medical Services Scheme, the Health (Amendment) Act 1996 , the Mental Health Act 2001 , the National Cervical Screening Programme, the Primary Childhood Immunisation Programme and the National Immunisation Programmes.

5. Subject to Regulation 6, the amount of the payments specified in column (3) of each Schedule opposite a particular reference number in column (1) thereof is prescribed as the payment to be made to a service provider in respect of the particular service specified in column (2) thereof.

6. 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 10 or 21 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.

7. The Public Service Pay and Pensions Act 2017 (Payments In Respect of Certain Services Under the Health Act 1970 ) Regulations 2019 (S.I. No. 290 of 2019) are revoked.

SCHEDULE 1

Services rendered under the General Medical Services Scheme – Agreement of 2019 – general practitioner capitation rates (all amounts inclusive of former payments towards practice maintenance, equipment and development and former payments in respect of discretionary medical cards) Reference Number (1) Description (2) Amount (Total) (3) 1. Male patient aged under 5 years – where GP does not hold an under 6 contract €74.59 2. Male patient aged 5 years - where GP does not hold an under 6 contract €43.29 3. Male patient aged 6 years or more and less than 16 years €53.38 4. Male patient aged 16 years or more and less than 45 years €68.15 5. Male patient aged 45 years or more and less than 65 years €136.12 6. Male patient aged 65 years or more and less than 70 years €143.39 7. Patient aged 70 years or more residing in the community €334.95 8. Patient aged 70 years or more residing in a private nursing home (approved by the HSE) for continuous periods in excess of 5 weeks €535.38 9. Female patient aged under 5 years – where GP does not hold an under 6 contract €72.76 10. Female patient aged 5 years – where GP does not hold an under 6 contract €43.79 11. Female patient aged 6 years or more and less than 16 years €54.00 12. Female patient aged 16 years or more and less than 45 years €111.44 13. Female patient aged 45 years or more and less than 65 years €149.57 14. Female patient aged 65 years or more and less than 70 years €159.97 15. Supplementary out of hours fee €3.64

SCHEDULE 2

Services rendered under the General Medical Services Scheme – Agreement of 2019 – payments in respect of delivery of Chronic Disease Management Programme Reference Number (1) Description (2) Amount (3) 1. Annual fee payable in respect of eligible patient (aged 75 years and over) with one of the chronic conditions listed in the Agreement of 2019 €210.00 2. Annual fee payable in respect of eligible patient (aged 75 years and over) with two of the chronic conditions listed in the Agreement of 2019 €250.00 3. Annual fee payable in respect of eligible patient (aged 75 years and over) with three or more of the chronic conditions listed in the Agreement of 2019 €300.00

SCHEDULE 3

Services rendered under the General Medical Services Scheme – Agreement of 2019 – payments in respect of delivery of Diabetes Cycle of Care Programme Reference Number (1) Description (2) Amount (3) 1. Once-off registration fee per patient with Type 2 Diabetes aged 18 years or more and less than 75 years registered on the Diabetes Cycle of Care Programme €30.00 2. Annual capitation fee per patient with Type 2 Diabetes aged 18 years or more and less than 75 years registered on the Diabetes Cycle of Care Programme €100.00

SCHEDULE 4

Services rendered under the General Medical Services Scheme – Agreement of 2019 – out- of -hours payments (in respect of consultations other than day...