Fees and allowances paid to GPs for providing care to medical-card patients increased by more than €21 million last year.
More than 1,800 GPs earned a total of €317.5 million for the service, according to figures released by the Health Service Executive on behalf of the former General Medical Services (Payments) Board yesterday.
They show two named Dublin GPs - one in Raheny and one in Foxrock - each earned over half a million euro in fees for caring for medical-card holders in 2004.
The HSE said these were payments to individual GPs while the Irish Medical Organisation (IMO) said they were practice payments, which could cover the salaries of a number of doctors.
The highest-paid GP under the scheme was Dr Anthony Crosby, Raheny, who is listed as having been paid €533,408 in fees and €62,171 in practice-support payments. The second-highest earner was Dr Thomas Brendan McCarthy, Foxrock, who was paid €544,613 in fees and €3,747 in practice supports.
Other well-known doctors listed include Dr John McManus, husband of Labour health spokeswoman Liz McManus, whose Bray practice was paid €293,380 in fees and €50,740 in practice supports; the practice of Dr Elizabeth O'Sullivan, wife of Fine Gael health spokesman Dr Liam Twomey, which earned €138,019 in fees and €25,000 in practice supports; Mayo Independent TD Dr Jerry Cowley's practice took in €271,530 in fees and €65,007 in supports; IMO activist Dr Martin Daly's Galway practice earned €297,741 in fees and €7,353 in practice supports; and Fianna Fáil TD Dr James McDaid's practice earned €88,506 in fees and €22,320 in supports.
Practice-support payments include grants to cover secretaries and nurses, and contributions to GPs for locum cover.
Minister for Health Mary Harney in a statement said the figures showed a "substantial amount of money" was paid to doctors for providing services to medical card patients. "It is important that we continue to get value for money from the scheme and that it is patient focused, and that is why we want to begin talks on a new contract to modernise primary-care services."
The IMO's GP committee chairman, Dr Martin Daly, said he too looked forward to talks on a new contract. "These payments are practice payments to designated doctors and may well support the payment of a number of doctors and other professionals.
"It should also be pointed out that the average working week of a GP is around 70 hours and that their GMS contract carries a 24-hour responsibility for patients. GPs provide a high quality same-day service for people with medical cards."
Dr Daly said all payments were taxed and the practice-support payments did not cover the full cost of providing services. In his own case, he said his payment covered four doctors, a practice manager, a practice nurse and two secretaries.
Meanwhile, details were also released of the amounts paid last year to pharmacies, dentists and opticians who provided services to medical-card holders. Payments to pharmacies amounted to €1,092.7 million, up from €943.21 million in 2003; payments to dentists came to €52.49 million; and opticians were paid a total of €17.44 million.
The biggest-earning pharmacy last year was run by Unicare. Its outlet in Stillorgan got over €1.4 million from the State for dispensing drugs to medical-card holders, and for dispensing to patients under the Drugs Payment (DPS) and Long-Term Illness (LTI) schemes. Pharmacists dispensing under the DPS and LTI schemes are reimbursed for the drugs they provide, get a 50 per cent mark up on them and a dispensing fee. Drugs dispensed last year came to €813 million, up from €706 million in 2003.
Ms Harney said the bill for drugs was very substantial. "We must renegotiate the contract with the drug providers to ensure value for money," she added.
Meanwhile, two Specsavers outlets were the highest earners for optical services provided to medical-card patients last year. A Letterkenny dentist, Dr Terence G Fox, was the highest-paid dentist for looking after medical-card holders. He was paid €306,963.
The GMS payments board said the increased level of payments last year reflects an increasing and aging population and a resulting growth in the number of people eligible to claim under the various State-funded schemes.